I’m David Lovett, and this is what I believe. Your comments, letters, and e-mails are welcomed; contact me at lovett@aaos.orgDavid A. Lovett, JD, is director of government relations for the American Association of Orthopaedic Surgeons (AAOS). The viewpoints expressed in this article are his own and do not necessarily reflect the positions or views of the AAOS.


Published 3/1/2010
David A. Lovett, JD

The lowdown on legislation

As AAOS Now went to press, the issue of healthcare reform was still being debated, and the shape of a final bill has yet to be determined. The American Association of Orthopaedic Surgeons (AAOS) has expressed its opinion to members of both the U.S. House of Representatives and the Senate. AAOS President Joseph D. Zuckerman, MD, has played a significant role in the healthcare reform debate, not only within the orthopaedic community but also among surgical specialties, rallying them to take a unified position when interacting with Congress.

By the time this article is published, the healthcare reform train may have grinded to a complete halt for several reasons. Speaker of the House Nancy Pelosi (D-Calif.) has a supermajority of Democrats in the House (by about 70 members), sufficient to move any bill. But the Democratic leadership has made healthcare reform less of a priority.

Then there is the Senate problem, and the need for 60 votes to move any bill forward. This situation is not easily solved, and the addition of Scott Brown as the new Republican senator from Massachusetts only exacerbates an environment where collegial cooperation—never easy to achieve—is now almost nonexistent. Even within the same party, there is great divisiveness.

When I first worked on the Hill as a high school intern, it was a more collegial place. Then came Watergate, and, as they say, the rest is history. The spirit of cooperation has been trumped by the drive to be re-elected. Partisanship has paralyzed the republic, and the political bandwagon is missing a wheel.

Now, whether or not the House and Senate agree to a healthcare reform measure, the deficiencies of the bill will likely remain the same. Meaningful healthcare reform is not really on the radar screen. Substantial reform provisions should include medical liability reform, antitrust reform, insurance reform, and a permanent fix to the broken sustainable growth rate physician payment formula under Medicare.

The House and Senate also fail to realize that there is not just a shortage of primary care doctors, but of all healthcare professionals—from nurses to surgeons.

To truly address healthcare costs, politicians will need to take on the costs associated with beginning- and end-of-life issues. Most Medicare dollars are spent in the last 30 days of life, and how much of the healthcare dollar is spent on caring for infants born prematurely is unknown. These difficult topics, however, are not likely to be addressed by Congress.

If Congress is too timid to address these issues, I have a very easy solution that will cost less than $800 billion and will involve little government bureaucracy. Simply allow physicians to write off indigent care as bad debt, or give them a tax credit for providing care to the uninsured. Such a move would not only practically solve most of the country’s healthcare needs, it would also be cost-effective.