Notwithstanding Harry Reid’s plethora of public statement snafus, Ben Nelson’s being booed out of a popular restaurant in his hometown on his health reform behaviors, and despite the fact that Republican Scott Brown won the “Kennedy” Senate seat over Democrat Martha Coakley in Massachusetts (wiping out the 60^th Dem vote needed for reform in the Senate), I remain optimistic about health reform.Mr. Reid and Ms. Pelosi seem to have a very shaky but barely sufficient majority of votes needed to move a compromise bill through both houses and on to the President in time for the State of the Union. Who would have thought this to be possible a month ago? Of course, lots of things could derail it, but it seems to be moving forward.

The ACC, along with most of medicine, is extremely concerned about the proposed IPAB (Independent Payment Advisory Board), which is an outgrowth and evolution of the IMAC (Independent Medicare Advisory Commission), itself a version of ‘MedPAC-on- steroids.’ The Senate has of late proposed the IPAB consist of 15 physicians that would oversee (guess what?) physician spending. Hospitals, long-term care and pharmacy costs would seem to be excluded.

What? First we have the SGR as a volume-based expenditure target for doctors only, and now we are going to have a second process to limit physician spending? At the same time, hospitals will continue to have their “market basket” formula, which gives them a tidy 2 to 4 percent increase every year, without expenditure targets. Until we physicians decide to increase our investment in our future (and the future of our patients) by getting more involved in the political action and PAC activities, the hospitals, health plans will continue to have much more leverage than we do.  It looks now like the SGRrrr will get only a short 2-3 year fix in the talks this weekend. No good.

The ACC is also pushing still for tort reform, including certificates of merit, health courts and other provisions that a fairly large number of Democrats will support. Of course, we could get support for tort reform from almost the entire contingent of Republicans in both the House and Senate, except they won’t help now because they don’t want to give the Democrats any credit for something they believe is their domain. Some progress on tort reform looks possible. The ACC signed on to a multi-society letter drafted by the Health Coalition on Liability and Access (HCLA). We are a member. HCLA lobbied for the kind of tort reform language that the ACC has long supported directly with Harry Reid and Nancy Pelosi this week.

Health reform may be imminent. Hold your breath. Whether you want to see this proceed or are adamantly opposed, the nation could be doing something as significant as occurred in 1965 with the establishment of Medicare and Medicaid soon.

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