Gridlock vs. the Greater Good

In a flurry of activity in Washington, DC and New Hampshire, two sets of lawmakers addressed a broken physician pay system and poor adults without health insurance. Guess which group got gridlocked and which one rendered a public service that will actually help people.

"It has been said that democracy is the worst form of government except all the others that have been tried." – Winston Churchill

For me, the past week has been a tale of two cities.

In Washington, DC, the potential for political gridlock to derail even bipartisan healthcare reform efforts was on full display. It took about a year for Democrats and Republicans in both houses of Congress to craft a "Doc Fix" for Medicare's broken physician payment system.

After two months of squabbling over the new value-based payment system's $180 billion tab, Congress punted, voting to patch Medicare's much-maligned Sustainable Growth Rate formula rather than to replace it.

The American Medical Association released an exasperated statement soon after the Senate endorsed the House version of the "Doc Fix" patch Monday night: "The American Medical Association is deeply disappointed by the Senate's decision to enact a 17th patch to fix the flawed Sustainable Growth Rate (SGR) formula. Congress has spent more taxpayer money on temporary patches than it would cost to solve the problem for good."

In an alternate reality last week at the Statehouse in Concord, NH, the potential for politicians to work together to enact healthcare reforms in the interest of the general citizenry soared like the frosty peaks of the White Mountains.

NH lawmakers and Gov. Maggie Hassan, (D-Exeter), capped a year-long effort to expand Medicaid to more adults under the age of 65. The Granite State's Medicaid expansion law, which was formed in the Republican-controlled Senate with Democrats at the table, will use federal Medicaid dollars to help income-eligible adults buy private health insurance policies on the state's new public exchange.

I live in New Hampshire and was filled with pride last week after speaking with two of the architects of the state's Medicaid expansion compromise: Sen. Nancy Stiles, (R-Hampton), and Rep. Tom Sherman, a Rye Democrat and practicing gastroenterologist. Stiles and Sherman get it. They understand that when it comes to essential elements of American society – such as our healthcare delivery system – the greater good has to trump narrow political interests.

"Healthcare is going to be expensive," Stiles told me in phone conversation while House lawmakers debated the Senate's Medicaid expansion bill last Wednesday. "This was not only bipartisan. The House was involved, too."

After last week's House vote, Sherman told me he had decided more than a year ago that federally financed Medicaid expansion was an offer states would be foolish to refuse. "States are leaving a lot of people uninsured," the freshman lawmaker said of the two dozen states that are either resisting Medicaid expansion or struggling to find ways to make expansion work. "But they're also leaving a lot of money on the table."

Sherman was ecstatic over last week's accomplishment, which will provide access to healthcare to as many as 50,000 previously uninsured NH residents. "It never would have crossed my mind that I would be able to help the health of 50,000 people," he said. "To have an opportunity to make a difference on this scale is mind-boggling."

But Sherman also displayed a level of politically healthy humility that is all too often lacking in Washington.

"No one person should take credit. I think it's a collaborative move," Sherman said of New Hampshire's Medicaid expansion law. "That whole process, which has been a yearlong process, is clearly the best solution for the whole state… People put aside everything except what was the best thing for the citizens of New Hampshire. This was a unique and time-limited opportunity to lift a significant portion of our citizens out of financial and healthcare uncertainty."

It has been 75 years since the first screenings of "Mr. Smith Goes to Washington" starring James Stewart. Hollywood producers should cast Dr. Sherman in a remake. And voters should send more lawmakers like him and Nancy Stiles to Congress.