Lame Ducks and Turkeys Coming Home to Roost

• AUSTIN

While the Democrats were sweeping both congressional chambers and turning over half the governor’s mansions deep blue, Texas merely acquired a slight purple tinge, a bruise of sorts. There is a considerable

array of what-ifs to contemplate both in Austin and Washington with this reconstituted set of legislative bodies, which we’ll speculate on shortly.

Meanwhile, the most immediate threat to physicians’ socioeconomic health is the current lame duck congressional session where they may get their gooses cooked by Christmas. Some very large portions of Medicare have been laid on the table under the most unpleasant of political circumstances: A toxic mixture of Republicans with a thirty to forty-five day life expectancy before going the way of the dinosaur, their surviving, now-minority party colleagues, who are wrapping themselves around the dual axles of finger pointing and grief, and a narrow Democratic majority oscillating between payback, their own who’s-incharge internecine competition, and (probably) insincere gestures about a new era of bipartisan cooperation. Then things get really uncertain as all these happy campers convene for one more round of kumbayah. Offices are being vacated with the ensuing scramble for better accommodations. Committee chairs are being surrendered, staffs purged, loyalty tests administered, and deck chairs rearranged for the next session’s voyage. The ship of state now lists to port instead of starboard, no less stable than before. One political cartoonist depicted the changing of chairs as, “We broke it, you own it.”

Speaking of broke, here comes the medical profession in waves of flyins from before Turkey Day until the holidays, landing in this less than charitable environment, asking for, depending on the specialty: a few dozen billion dollars to stop a reversal of the scheduled 5 percent reimbursement cut, a pay raise for E&M codes, a hold on the cuts last cycle in the “deficit reduction act,” and several re-dos of some CMS rules that, among other things, make outpatient imaging, including cathlabs, a distant memory, and ration power mobility devices for the disabled to every sixth patient. Ho-Ho-Ho. Yes Virginia, and Texas, and all the rest of you, there is no Santa Clause. Or even an amendment. The joke is on all of us. Which reminds me of an old joke: A guy walks into a bar with a duck on his head. Bartender asks, “What can I do for you?” The duck replies, “how do I get this guy off my ass?”

This Congress would rather take a beating with a wet rope than stick around Washington until Santa comes trying to fix what they’ve been slapping Band-Aids on for six years and counting. My guess is the Band- Aid this time will be a continuing resolution, or a CR, in lobby parlance, to get them home for the holidays. The bipartisan consensus is still sitting there, but not many have the stomach for this between now and January. The can very likely gets kicked into the next session, again.

So what will they do? Will the Republicans say, “You want the wheel, you’ve got it?” Will the Democrats make a deal with their lame duck colleagues, or just wait until January when they won’t be sitting on their heads? What if January rolls around and the SGR falls over the cliff, the closet rationing by CMS sticks, and the DRA cuts go into effect? Will the returning old lions of health care policy on the committees of jurisdiction —Henry Waxman and John Dingell, Charlie Rangel and Pete Stark, take prisoners or watch medicine twist of a long rope?

I think after a course of fried duck, the new chairs won’t put off the inevitable. Dingell made a concerted, and near successful, run last session to force an automatic pay raise for physicians. They get it, just haven’t got to it. They are also contemplating rounds and rounds of the political equivalent of show trials on every aspect of corporate health care, consistent with parallel efforts into war profiteering and other corporate excesses—Spitzer on steroids, on a national scale. As one prominent attorney commented some time back

This Congress would rather take a beating with a wet rope than stick around Washington until Santa comes trying to fix what they’ve been slapping Band-Aids on for six years and counting. My guess is the Band-Aid this time will be a continuing resolution, or a CR, in lobby parlance, to get them home for the holidays.

on the profitability of non-profit hospital systems: “We’re paying for universal health care, we’re just not getting it.” Ramparts are being manned all along the defense lines among the usual suspects: the pharmaceutical industry, commercial managed care, the non-profit-in-name-only systems, the medical device folks, and all the middle men. Needless to say, we can expect further inquiries into the unsavory business of self-referrals by that body of law’s namesake. There are ponies in this pile of issues as well, but they will likely want to first catch up on old business. Payback is a (reference to canine ancestry).

Texas’ horses are a slightly different color. The governor won with 60 or so percent of the voters preferring someone else, including 18 percent for a professional comedian. The lieutenant governor has a transparent wish to succeed him, and the Speaker’s iron grip on his charges was loosening voluntarily—perhaps now somewhat involuntarily. There is a more open uneasiness among them and their congressional counterparts, after the Roveinspired strategies of pump-the-base looked more like a slowly deflating Hindenburg. One columnist asked after the election what Rick Perry and Tony Sanchez have in common?