What a week we’ve had on Capitol Hill! Congress  overrode President Bush’s veto of H.R. 6331 — whew. This was a tremendous victory for the medical profession and for cardiovascular specialists in particular, who flooded congressional offices with their calls and e-mails.

On the way to this goal, ACC President Doug Weaver this week visited Rep. Charles Rangel (D-N.Y.), chairman of the House Ways and Means Committee; Rep. Allyson Schwartz (D-Pa.); Sen. Debbie Stabenow (D-Mich.); Rep. Jim Matheson (D-Utah); and Rep. Ron Paul (R-Texas). He had very positive personal discussions around health system reform and how to develop new quality-incentivized payment pilots, as the ACC has proposed, to transition away from the un-sustainable growth rate (SGrrrrr).

I was also honored to be invited to testify Tuesday before the House Ways and Means Committee Health Subcommittee about our views on access to care. I offered a brief history lesson on my experience with state-based access to care reforms in Hawaii and California, as well as some thoughts on how those experiences can inform the current debate. There was vigorous debate and Q and A. My messages were:

• State reforms are important, but without national reform policy, they will languish and not be effective.
• We shouldn’t just drop or dis-incentivize employer coverage for the 180 million Americans currently covered---this could shift huge numbers of currently insured people to be uninsured and to emergency rooms for primary care. There are real advantages to move to “individual coverage” for workers not insured in the agricultural, retail, food services, and small business sectors to promote more choice and portability of coverage. That will require big changes and major insurance reforms to work, but it makes long-term sense. But why not also create national policy to extend needed insurance reforms, promote portability, and guarantee multiple plan choices for those covered currently by employers through state and regional purchasing cooperatives like the federal employee FEHBP to all those covered by employers? This would provide portability and choice.  
• We also need payment reforms with incentives to promote quality, HIT, and to reward reductions in unnecessary administrative wastes. These are big steps that cost next to nothing.