Speaking at the Orthopaedic Political Action Committee (PAC) luncheon during the 2013 AAOS Annual Meeting, former Senator Jon Kyl (R-Ariz.) encouraged orthopaedic surgeons to personally engage their representatives on both sides of the aisle. Simply giving money to the PAC is a good first step, he explained, but it must be coupled with personal engagement.

Sen. Kyl admitted that convincing staffers to arrange a meeting with the legislator may take some effort at first, but he said it can be done.

“Be very firm, but very nice,” he suggested. “You can get a meeting if you’re persistent.”

Once a meeting is arranged, Sen. Kyl advised attendees not to go alone, but to invite others in the medical community to accompany them.

“Take two or three of you,” he said. “Take the physician who cares for the representative’s kids. Make a personal connection and tell personal stories about real people. Let the representative know what the legislation means to his or her constituents,” he said.

After that first meeting, Sen. Kyl said it’s important to discuss the intricacies of the legislation with the legislator’s staff.

“It is incredibly important to support the people whom you know will do the best job,” he said. “But it’s also important to educate them, because without that, they can make mistakes just as well as anybody else.”

Legislative concerns
Sen. Kyl also addressed ongoing issues in Washington, such as the concerns about the Medicare Sustainable Growth Rate (SGR) formula and the Medicare Independent Payment Advisory Board (IPAB), which, under the Patient Protection and Affordable Care Act, would be able to set reimbursement rates starting in 2014.

“There’s a lot of talk about SGR reform this year,” he said. “Rep. Fred Upton (R-Mich.) has said he’ll have legislation on the floor by summer. I just hope that, if this occurs, you are ready for a replacement. Because it could well be that the cure is worse than the disease, if you’re not careful.

“You know the value of what you do,” he continued, “and how it can best be done; how you can best take care of your patients. You have an obligation to your patients to tell that story.”

Stuart L. Weinstein, MD, speaking from the audience, pointed out that bipartisan support for repeal of the IPAB has been growing in the U.S. House of Representatives. What, he asked, are the chances for passing an IPAB repeal bill in the Senate?

“Slim and none,” responded Sen. Kyl. “But that doesn’t mean you shouldn’t try. These battles take a long time, and as Obamacare rolls out, all of its warts are going to become more and more apparent. Eventually, some kind of legislation will be needed to fix some of the technical problems, if not the substantive problems like IPAB. Identifying what the key problems are and getting people talking about them are very important parts of the process.”

Ongoing dichotomy
Discussing the ongoing gridlock in Washington, Sen. Kyl said that, although many legislators and President Obama have iterated support for entitlement reform, reform legislation has been unable to move forward. According to Sen. Kyl, the Joint Select Committee on Deficit Reduction (Super Committee), which failed to reach a deficit reduction agreement in 2011, was established primarily for the purpose of entitlement reform.

Although Republicans assigned to the committee proposed what he called “architectural reforms” to programs such as Medicare, Medicaid, and Social Security, the Democratic members “would not even agree to cuts around the edges of those programs, unless Republicans were willing to raise taxes by $1.3 trillion over the next 10 years.

“You can see we had a bit of a dilemma,” he said. “The process failed because of that dichotomy in views. Most of those views are still prevalent.”

Sen. Kyl admitted that many of the attitudes reflected in the Super Committee matched the mood of the nation itself; that ideological split, he said, is one of three factors that have worked to encourage members of both parties to remain entrenched in their positions.

“A good part of the country would like to see the United States government take a growing role in caring for people,” he said. “That would require more taxes. On the other hand, a very significant chunk of the population shares my viewpoint, which is that decisions of how to do these things are better left to the private sector, to individual Americans, which probably involves taking less money from the private sector and encouraging the economy to grow better and faster. Until something changes that dynamic, it’s very difficult for either side to compromise.”

Gasoline on the fire
The second factor, Sen. Kyl said, lies with President Obama, whom he described as “not a negotiator.”

“He believes he has been very successful in reaching the American people,” said Sen. Kyl. “And the last election would suggest that he’s right. He won the debate about taxes, for example. At least he got reelected. And he’s supremely confident in his ability to persuade. So he doesn’t have much of an incentive to compromise, from his point of view.”

He then went on to describe the third factor, which he called “the gasoline on the fire.”

“In the last several years,” he explained, “with the advent of talk radio, cable television, and a mainstream media that’s more interested in covering the contest than the content, we have perpetual campaigning. The day after the last campaign was over, it was all about, ‘Who’s going to run on the Democratic side? Hillary or Joe? Among all those Republicans, who might be the next nominee?’

“Because stations have to fill the air constantly, politicians are constantly challenged to be involved in that debate. When I first came to Washington, you’d take about 15 or 16 months’ time out and legislate after an election. You could get a lot done during that time.”

During the question-and-answer session, Sen. Kyl addressed one final factor in legislative gridlock.

“Redistricting around the country has created a pernicious situation,” he explained, “in which most of the districts in the House of Representatives are now ‘safe,’ either for a Democrat or a Republican. That tends to make people who run in those districts reflect their base. So candidates tend to be more liberal or more conservative than if the district were more of a 50/50 proposition. Only about 80 districts out of the 435 House districts are really competitive anymore.

“Running for the Senate,” he said, “is a big eye-opener. You have to appeal to all the constituents in the state. It makes you want to think long and hard, because you’re representing all of the people in the state. That’s one reason I think that sometimes Senators appear to be a little bit more willing to work together; a little more moderate than members of the House, where the two sides go to their corners and just never fight it out.”

This story adapted from the AAOS Now Daily Edition, Thursday, March 21, 2013.

Peter Pollack is a staff writer for AAOS Now. He can be reached at ppollack@aaos.org