Keynoter: 'Lobby like crazy'

Sept. 30 - Oct. 3, 2003

ASSEMBLY EDITION • NEW ORLEANS

BY TONI LAPP

Physicians should get their patients involved in the lobbying effort to change the Medicare reimbursement landscape, said keynoter Morton Kondracke during Thursday's opening ceremony at the Scientific Assembly. Kondracke, executive editor of the biweekly political newsletter Roll Call, brought this and other insights to his address, delivered in the casually droll manner seen in his appearances as a panelist on the TV discussion forum The McLaughlin Group.

"Why not enlist patients to do lobbying now (for changes in Medicare) rather than wait till they've been denied treatment?" keynote speaker Morton Kondracke asked attendees at yesterday's opening ceremony.

Other topics up for discussion included the "perfect storm" that is brewing as more Americans lose insurance in a climate of rising health care costs, the role health care will play in presidential platforms and the reimportation of drugs from Canada.

Medicare

It's unlikely that Congress will produce a Medicare prescription drug bill by Oct. 17, said Kondracke. It's important politically and could be a campaign issue, but President Bush himself would have to roll up his sleeves and work on it because of the insurmountable differences between the House and Senate on the issue. It's likely a smaller measure will be passed that offers a discount card for seniors.

Regarding the declining reimbursements for physicians, the formula being worked on in Congress probably won't include a fee schedule fix for physicians, but it will probably include one for hospitals, Kondracke said. His advice to physicians was simple: "Lobby like crazy if you want to change this picture."

"If reimbursements keep going down, physicians won't take new Medicare patients," he said. "Why not enlist patients to do lobbying now rather than wait till they've been denied treatment?"

Reimportation of drugs

Governors see reimportation as a way to decrease Medicare costs and ease their own budget crises. Although the Bush administration opposed the reimportation bill when it was going through Congress, Kondracke said, Bush "won't veto it if this is the only legislation he can hold a Rose Garden ceremony around."

Kondracke said his experience on behalf of his wife, a Parkinson's disease patient, made him sensitive to the issue, but he said Congress' attempts to legislate a remedy were "odious." Such legislation would discourage research of new drugs, he said, noting that it was difficult to name the last drug to be developed in Canada.

"The next 'John Q. Public' (movie) will be about drug companies," he said.

When it comes down to it, however, he sees little for lawmakers to do to alleviate the situation. Look for pharmaceutical companies to develop public relation problems that HMOs did in the 1990s, he said.

Election 2004

It's going to be a close election, Kondracke predicted, offering candid comments about the presidential candidates -- and Bush.

"Democrats sense that health care is a weak issue for Bush, and they all have a plan. ... They compete on how they can outdo each other by attacking Bush."
On President Bush: He is "vulnerable on health care ... he has a $500 billion budget deficit so he's stymied; he can't increase taxes because it's against his religion."
On Howard Dean: "He is serious about health care and will make it a key issue." Unfortunately, if elected with a Republican-controlled Congress, the situation would "resemble Hillary Clinton's health care reform" attempts of the early 1990s.
On Richard Gephardt: His health care plan is "ambitious and controversial." He would repeal Bush's tax cuts and give to businesses to provide a minimal level of health insurance for their workers. "His opponents point out that the Gephardt plan showers money on corporations."
On Wesley Clark: "He's an upstanding guy, but wet behind the ears politically. He only decided a month ago that he's not Republican."

Kondracke recommended physicians visit the Web site of the Commonwealth Fund (http://www.cmwf.org) to see the various candidates' health care proposals.

"Unfortunately, there are so many candidates, and health care is so complicated, that it rarely gets debated, so the public can't get educated about medical economics," he said. "The details are lost to the average voter."

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