In the early 1980s, David Kinzer, then a Massachusetts Hospital Association executive, wrote about the schizophrenia that hospital officials show toward conservative Republicans.
While attending an American Hospital Association convention at which a Reagan administration official spoke, Kinzer was surprised that AHA members gave the speaker a warm ovation after he promised to reduce spending on social programs such as Medicare and Medicaid.
Fast forward to January. Speaker of the House Newt Gingrich (R-Ga.) told members of the AHA in Washington that he wanted to "rethink Medicare from the ground up" and pledged to balance the federal budget by 2002. Though it was clear that what Gingrich was proposing would result in massive reductions in projected Medicare and Medicaid spending-as much as $300 billion in Medicare spending reductions over a seven-year period alone-Gingrich received a standing ovation from the crowd.
This behavior is not peculiar to the AHA. At a recent American Medical Association legislative conference and the Federation of American Health Systems' annual meeting in Dallas, Gingrich received standing ovations after similar speeches.
It's not news that a majority of hospital executives and physicians are conservative. But at a time when the budget fight to end all budget fights is warming up, a dichotomy between their philosophies and economic interests creates a challenge for the groups representing them.
On one hand, as AHA President Richard Davidson likes to say, it's easier to talk to your friends than your enemies. Over the past several weeks, the AHA has had hospital executives from around the country talking to the 120 House members they consider key players in the budget battle.
The hospital executives have a two-pronged attack, arguing that the size of the proposed Medicare spending reductions being contemplated by Congress is too great and that care should be taken to ensure that necessary cuts are made as painless as possible.
But there is another side. After the AHA meeting, a Republican staff member told reporters that the ovation for Gingrich showed that hospital officials support Medicare and Medicaid reductions. Furthermore, some AHA members have been reticent to question their representatives about the size of the Medicare cuts, choosing instead to talk only about how the cuts should be made.
Other hospital representatives are finding a similar problem. Thomas Scully, president of the Federation of American Health Systems, said last week that he also was having trouble getting his membership to understand the magnitude of the Medicare cuts being considered. "(Federation members) think Republicans are going to take care of them. They don't understand what they may be in for," he said.
That kind of mixed message is never productive in Washington, where the squeakiest wheel invariably gets greased.
Those who gave Gingrich a standing ovation are right when they say the federal debt load and the solvency of the Medicare trust fund need to be addressed. And there is no reason why hospital executives or physicians should go against their political preferences simply for their own financial interests. But neither should they be surprised if their own words, or in this case their own standing ovations, eventually are used against them in the coming budget battle.
A real donnybrook doesn't occur often in Washington. Because every member of Congress is dependent on every other member-and on special interest groups-feuds tend to end quickly and quietly.
But two big ones are brewing, and both involve Sen. Alan Simpson (R-Wyo.).
One battle pits Simpson against the American Association of Retired Persons, which he calls an "organization of people brought together by a common love of discount air fares."
Simpson's main beef with the AARP seems to be its vocal, and often rigid, defense of the Medicare and Social Security systems. He believes that the AARP's methods are counterproductive to the reforms needed to save the systems.
As part of the presidentially appointed Bipartisan Commission on Entitlement and Tax Reform, which disbanded at the end of last year, Simpson had a forum to vent his frustration against the AARP. Later this month, Simpson and the commission co-chairman, Sen. Robert Kerrey (D-Neb.), are expected to introduce a series of bills designed to reduce entitlement spending. Included will be proposals linking Medicare premiums to income. Such thoughts are strongly opposed by the AARP and are sure to fan the flames of the feud.
The AARP is not Simpson's only battle. A less public fight also has been simmering between Simpson, who is the chairman of the Senate Veterans Affairs Committee, and several veterans service organizations, which fear the lawmaker is bent on destroying the veterans healthcare system.
After losing his spot as the Senate's second-ranking Republican, Simpson took over the Senate Veterans Affairs Committee, a position he held the last time the Republicans controlled the Senate from 1980 to 1986.
Simpson has been a ceaseless critic of veterans service organizations, calling their leadership "professional fund-raising veterans." Simpson also has contended that the groups' intense interest in the VA healthcare system is more a tool for boosting membership than genuine concern for the system.
For their part, the service organizations haven't been shy about criticizing Simpson. The groups say Simpson is far more interested in reducing the deficit and cutting federal spending than in seeking adequate funding for what they view as an underfunded VA health system (Dec. 12, 1994, p. 25).
It's too early to tell what will happen when the Republican-controlled Congress begins to move a budget later this year. In its first round of cuts, taken from the 1995 budget, Senate Republicans called for more than $100 million in VA appropriation cuts.
Word from Washington, a monthly column by MODERN HEALTHCARE