Today the AARP and American Cancer Society endorsed the House health-care bill, with the American Medical Association expressing its positive (if qualified support). But amid this big news, a strong message of dissent was sent to the Senate side of things -- and it didn't come from Bachmann's tea-party spectacular on Capitol Hill.
In a letter sent to Senate Majority Leader Harry Reid today, the American College of Surgeons and 19 other physician groups stated their strong opposition to the current Senate legislation as based on the provisions in the Finance Committee's bill, primarily due to fears that it will not fix the Medicare payment system to doctors and will find other ways to cut down provider fees. The group wrote: "If these concerns are not adequately addressed when a health care reform package is brought to the Senate floor, we will have no other choice but to oppose the bill."
At heart, the AMA's qualified support of the House bill and the surgeons' problems with the Senate bill are rooted in the same key issue: fixing Medicare's flawed payment system for providers. As Jonathan Cohn points out, in the endorsing health reform, AMA underscored the fact they they were supporting not one but two bills: the primary bill Nancy Pelosi has put forward, and a separate $210 billion bill that would do away with planned reductions to Medicare physician payment to bring them in line with the Sustainable Growth Rate (SGR). On the Senate side, however, the attempt to pass a version of the latter -- the so-called doc fix -- failed when Senate Democrats joined Republicans to defeat a $245 billion, unfunded bill. And ACS's letter today intended to send the message to the Democrats that such a move was unacceptable.
So, in different ways, both the AMA and ACS made it clear today that their support for the health-care legislation is significantly contingent upon Congress's ability to pass some form of "doc fix." Problem is, it's far from certain that this will happen within the time frame of health-care reform debate. As Cohn notes, "Congress seems disinclined to pass an SGR fix, even as a separate bill, without new revenue or savings to offset the cost" -- and finding extra money will be extraordinarily difficult. If that's the case and the doc fix doesn't get passed, will doctors and surgeons end up turning against health reform? Surgeons certainly issued a credible threat to the Senate today.