Blood on the Tracks
Dealing from the bottom of the deck. Winning at any cost. If I can’t get what I want from you at the front door you might find me crawling in your window at midnight. Politicians like to say they care about transparency, just like many of them claim to be a “person of faith”. Not quite sure what that has to do with anything but it is bound to be worth a few votes on Election Day. Who wants to vote for a person of “non-faith”? Those who make our laws seem to be a pretty good reflection of the population at large. Of course, once you are in office the Power comes and that means money. I don’t have the psychic energy to go into the details of the cabal of lobbyists and moneyed interests that permeate Washington. It is a law of nature that when policy is being made there will be an attempt to influence the direction of that policy. So far so good, or at least acceptable. However, when the level of influence is a direct result of “special” access, that might not be so good. I wonder if this type of access was the vision of the Founding Fathers (and Mothers). When the Affordable Care Act was being debated and authored who was invited to sit at the Table of Power in Washington? Probably not too many representatives of those without insurance. Probably not too many who espoused an interest in making changes to the most sacred cow of all, Medicare. This is all so obvious that I am embarrassed to bring it up and waste your time. You know it is true, the System is stacked against those without influence.
I cannot ever imagine this changing. Influence by power and money will continue to rule the political stage until we are finally delivered by the arrival of the Age of Aquarius. I’ve been waiting for that since 1967, the Summer of Love. I’ve gotten pretty good at waiting and have kept myself occupied by having a family, paying a mortgage, and trying to smell the roses. I’ve made peace with most of the revolutionary demons of my youth. However, what still sticks in my craw is the willingness of politicians to demonstrate outrageous behavior to further an agenda without debate, transparency, or having to leave any fingerprints at the scene of the crime. These practices seem un-American but maybe that is just the veil I peer through. This could actually be very American coming out of the shadow of having to win at any cost. Conquer the West, civilize the indigenous, tame the rivers, cut down the old growth forests that once blanketed the Appalachians. There is a heady dose of that DNA in the blood vessels of America. If I can’t win in a fair fight, well, I’ll have to quit fighting fair. If I can’t get what I want from your front door you might find me crawling in your window at midnight and I might have to bring an ice pick.
Now I don’t know anything about Representative Joseph Pitts of Pennsylvania but I have to admire the way he put a knife into the jugular vein of a major healthcare initiative and dropped it to the floor without so much as even a whimper. I mean this guy is good. Really good. If I’m ever in need of a quick fix he will be my go-to guy. So what if there is a little collateral damage? So what if established healthcare policy that has been debated and formulated for years has to be taken out to the back yard and shot like a dog with rabies? Who cares if there is a loss of credibility for CMS and erosion of the validity of transparent government? Who cares as long as someone gets what they want?
The International Classification of Diseases (ICD) is essentially a coding system used to classify diseases. The versions are updated on a regular basis and the US is currently using version 9 (ICD-9). So an ICD-9 code for one type of diabetes might be 250.0. Congestive heart failure is coded at 428.0. The next version, ICD-10, was endorsed by the World Health Assembly in 1990 and was widely used by many countries by the middle 1990s. That is probably all you need to know about that, let’s move on to setting the stage for the fix.
The original effective date for adoption of ICD-10 in the good ole’ United States was October 1, 2013. “Too soon! Too soon!” was the cry. So the Centers for Medicare & Medicaid Services (CMS) delayed that for a year until October 1, 2014. “Too soon! Too soon! We don’t have time to get ready! The sky might fall!” was heard again. But, alas, there would to be no more delays. Even CMS put their credibility on the line. In February 2014 CMS Administrator Marilyn Tavenner said there would be no more delays, “we have already delayed the adoption standard….several times, most recently last year. There will be no change in the deadline for ICD-10.” There was nothing left to do for those desiring another delay except go for the inside fix. Enter Representative Joseph Pitts of Pennsylvania, the Chairman of the House Committee on Energy and Commerce: Health.
Now I don’t know anything about the Kind Gentleman from Pennsylvania. Left, right, up, down. I have no idea of his theology, philosophy, or orientation. But in this case what was done, and how it was done, should be beyond the pale. Maybe we are all so jaded that it is impossible to be shocked by any behavior of our elected government. This issue at hand was not just another “bridge to nowhere”. The transition to a new ICD system is not really the issue. Everyone agrees it will eventually take place and it has nothing to do with who happens to occupy the Oval Office or the “noble opposition”. Since CMS would no longer cooperate at the front door it was time to go to the window for a fix. No more debate. No more public comments. No more transparency. Time to take the bull by the horns. Those folks at CMS needed to be bypassed completely. Time to employ a little strong arm action and settle this once and for all and show those pointy headed ivory tower types a thing or two. Time to go to the window. Time for a fix.
It was beautiful in a wicked way. It over before it started. No time for input from the other side. No time for those actually involved in healthcare policy to even know what was going on and try to apply the brakes to allow a little discussion. The time for talking was over. A quick flash of cold steel, the body slumps to the floor, and the deed is done. Checkmate.
It was one of the oldest of tricks in Washington. Take a bill that absolutely must pass, best to chose one involving Medicare. Let it get very close to a catastrophic deadline then slip in your one little sentence. No debate, not even a whisper. The bill was H.R. 4302, which had a lot to do with Medicare but nothing do with ICD-10. Just very carefully slide in Section 212 which only has our one lovely sentence, “The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD–10 code sets as the standard for code sets under section 1173(c) of the Social Security Act (42 U.S.C. 1320d–2(c)) and section 162.1002 of title 45, Code of Federal Regulations.” That as there was to it. Point, set, match.
The bill was sponsored by Representative Joseph Pitts on March 26th and immediately referred to Committee. The House voted on it the very next day. According to the Journal of the AHIMA the bill was “quickly pushed through the House on March 27 via a voice vote, where no roll call was taken, no votes were tallied, and with the majority of representatives still out on a previously called recess.” Sweet, very sweet. I looked at the video of the event on C-SPAN and it was all over in less than 30 seconds. I’m not kidding. It will freak you out how fast it happened. Talk about a done deal. That was on Thursday. It went to the Senate on Monday, which was working against a midnight deadline where we were told without passage of the bill the earth’s poles were going to shift and life as we know it would end. No time to debate or talk about the ICD-10 delay. If fact it was not even mentioned. Don’t waste your time watching the video of the Senate action. At least those folks recorded their votes as opposed to the House members whose fingerprints were not recorded for posterity.
There were some clear winners here. I’m thinking it was those who wanted more delays but couldn’t find anyone to haul their water any more at the front door. We have lots of losers but those are probably just a bunch of namby-pamby types who believe that Congress should represent all the people and there shouldn’t be a side window for those who like to whisper into the ear of those making our laws. Just a bunch of do-gooders who like to talk about something called the Common Good. I’m really not too upset at the Representative from Pennsylvania. I don’t know if he thinks this type of maneuver is legitimate, or “the Democrats did it to us”, or it’s “just the way things are”. I don’t know what was behind his actions. I imagine contributors to his political campaigns are not too dissimilar from many of his esteemed colleagues.
This is more than just about ICD-10. This is about the filthy business that reminds me of the ward bosses that ruled many of our greatest cities and ran them into the ground. Is this behavior really OK with everybody? I thought the safety net that bailed out those that created the Great Recession through financial shenanigans was an anomaly. Maybe I’m naïve and don’t understand how things work in the “real world”. Won’t someone stand up and say this lack of transparency and “access to the window” might be a problem? Senators, Representatives, even the President who promised “change we can believe in” please weigh in here with some comments to sprinkle a little hope around. I’m starting to feel a little bamboozled. Is anybody out there?