Given that most of the physicians currently in Congress are conservative Republicans, it may not be a surprise that physicians in the House of Representatives
voted 12-3 against the recently passed fiscal cliff legislative package. More unexpected is that one of the "no" votes came from a Democratic doctor, Seattle psychiatrist Jim McDermott.
"In any compromise, there are some good things and there are bad things," McDermott told Modern Healthcare. "There were a whole bunch of things that were reasonable (in the bill) and should have happened."
Among the provisions in the American Taxpayer Relief Act of 2012
that McDermott supported were measures to suspend for one year the Medicare pay cuts to physicians called for by the sustainable growth-rate formula
and to allow taxpayers in states without income taxes to continue to make itemized deductions for state and local sales taxes on their federal tax returns.
McDermott, who has held his Congressional seat since 1989, said repealing the SGR should have been part of the Patient Protection and Affordable Care Act. It shouldn't, he said, be part of a last-minute political deal between "two guys in a room, neither of whom can spell 'otolaryngology.'"
"It was an ill-conceived cost-control mechanism created on the back of a galloping horse," McDermott said of the SGR's origins in the Balanced Budget Act of 1997. "It's been a problem from the beginning."
McDermott noted that the president started negotiations seeking $1.2 trillion in new revenue and wound up with $620 billion in what will probably be the only time for the foreseeable future that Republicans vote for tax increases.
"From this point on, they're going to say, 'I gave at the office … and I'm not going to give again,' " McDermott said, adding that now, for future budget negotiations, "It's all going to be cuts."
McDermott added that he sees medical research being a likely target of budget hawks. This, he said, would be a shortsighted fix and could also create major problems for his state. According to the Association of American Medical Colleges (PDF)
, publicly funded medical research contributed almost $1.8 billion to Washington state's economy in 2009 and employed nearly 12,000 people.
If medical research funding is cut, "We're going to be in a world of hurt," McDermott said.
"When you start cutting investments in healthcare, you're hurting us long-term," he explained. "We're setting up long-term problems we're going to have a tough time fixing in the future."
Despite projected physician shortages in the near future, McDermott predicted that calls for increasing funding for graduate medical education
to expand the number of physician residency training positions may not be well-received.
The world has changed since the current Medicare-supported GME system was formed some 45 years ago, and reform is necessary to shape old laws to reflect new realities, McDermott said. So, to that end, he said a bill calling for an across-the-board increase
of some 15,000 residency slots is not much different from measures calling for across-the-board cuts.
"Let's figure out what we need to buy and let's buy it," McDermott said. "Let's buy the things we need and show why we need them."
In an effort to address projected primary-care physician shortages, McDermott introduced the Restoring the Doctors of Our Country through Scholarship Act of 2012 or RDOCS. Based on the U.S. Armed Forces' Reserve Officers Training Corps (or ROTC) which grants scholarships in return for military service, McDermott's bill would fund full scholarships to medical students in return for a five-year commitment to practice in a medically underserved area.
The bill was referred in September to the House Committee on Energy and Commerce's subcommittee, and it remains there.