Page 6 - Bulletin Fall 2024

President’s Message
“Prediction is very difficult, especially if it’s about the future!”
--Niels Bohr
Damian Caraballo, MD dcaraballo44@gmail.com
If July taught us anything, it’s that it is futile to try to predict the impli- cations of November’s election. In one month, we had an assassination attempt on former President Trump, while President Biden dropped out of running for president altogeth- er. This should serve as a warning for anyone doomsday prophesizing about what will happen if their op- posing candidate wins the election
in November—most predictions are wrong in a manner we never could have foreseen. With that huge grain of salt, I will predict the race in November; no matter who wins, the Re- publican or Democrat ticket, your day-to-day life as a physi- cian will not change much based on who is president.
That’s not to say elections aren’t important. In fact, I’d ar- gue that elections have huge implications on how we prac- tice medicine. I’d argue, however, that when it comes to the practice of medicine, the dictum in politics holds true—the most important politics are local politics. Who we choose as our local legislators, judges, US Congress, and state senators will have a much bigger impact than the president will on which laws, rules, and implementations dictate how to prac- tice medicine in the future.
In fact, I’ll make a bold prediction—the recent Chevron vs Natural Resources Defense Council ruling by the US Su- preme Court will have a bigger impact on the practice of medicine than the November election. In essence, the ruling overturned a 30-year precedence where Congress allowed its federal agencies to “fill in the gaps” in its laws and in- terpret US laws based on who was in charge of the agency. Put another way, it allowed non-elected bureaucrats running Federal agencies such as the FDA, EPA, and CMS to inter- pret and implement US law. The problem with this is that the heads of the agencies change every administration, so a Republican and Democratic-run agency could completely change the implementation of our laws every election.
There was no better example of this than the recent implementation of the No Surprises Act (NSA), passed in 2020 under President Trump. The law was passed to osten-
sibly ban balance billing, however, insurers tried to use it as a backdoor to implement what is known as the QPA—the qualifying payment amount. If it had passed as insurers lob- bied, the QPA would have essentially instituted a price ceil- ing on all hospital-based physicians. Per the Congressional Budget Office (CBO), it would have cut physician pay in the next 20 years by 20%. Fortunately, the AMA and the House of Medicine got their act together enough to avoid manda- tory QPAs and negotiate a compromise where we still were allowed arbitration, known as Independent Dispute Resolu- tion (IDR), as one final check on the trillion-dollar health- care industry. Health and Human Services Secretary, Xavier Becerra, however, in political gamesmanship, tried to skirt the NSA law and its intent and instead attempted to imple- ment the QPA regardless. Fortunately, the Texas Medical As- sociation sued the federal government and won (four times), allowing physicians to use IDR.
The NSA debacle is a harbinger of what’s to come with the Chevron ruling. The Supreme Court basically shifted power from agencies such as the HHS/CMS and announced open season on lawsuits vs federal agencies. This will in- crease the amount of litigation in healthcare, the results of which courts and state legislators will now fill in the pow- er vacuum. This also will lead to more regionalization of healthcare—laws and regulations on how to practice medi- cine in Florida might now be different than in Oregon based on state laws and lawsuits. This means that state and circuit judges—many of which we the people elect on November ballots—will play a much bigger role in how we practice medicine, get reimbursed, and even what is legal for medical practice in Florida.
It also means that the onus is once again on US Congress to take a more active role in “doing its job” and passing health bills. The 118th Congress (2023), one of the least pro- ductive in the history of the US, passed only 12 bills. Com- pare this to the 101st Congress (1989) which passed over 400 bills. Simply put, Congress has been in a political stalemate where it doesn’t really do much of anything other than argue on television and social media about how the other side is ruining America. When it does pass laws, it allows lobbyists and wonks to write vague language so that agencies such as HHS can determine how to implement the law. The Chev-
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HCMA BULLETIN, Vol 70, No. 2 – Fall 2024