Thursday, June 10, 2010

Interview with Lee Stilwell, Founder and CEO of The Stillwell Group, a Washington, D.C. Public Relations Health Care and Health Policy Consulting Firm

Lee Stillwell is founder and CEO of The Stillwell Group, a full-service global public affairs company with a strong life sciences practice. Mr. Stillwell has worked on both sides of the aisle in the U.S. Senate as a key aide first for an eastern Democrat and later in his career for a western Republican. For more than 18 years, Mr. Stillwell was the chief advocate for the American Medical Association (AMA). As senior vice president of the AMA Advocacy Group, he managed a staff of more than 120 employees in Chicago and Washington, D.C.

Q: What do you do for a living now?

A: I am consultant, founder, and CEO of the Lee Stillwell Group. We are located in Washington, D.C, and we are a public relations group specializing in health care and health policy issues.

Q: What is your political background in the nation’s capitol?
A: I started out as a journalist. That took me to Washington, where I was a national correspondent. From there, as my friends say, I went over to the dark side. I got involved in politics. Early in my career, I worked on the Democratic side for Senator Abe Ribicoff of Connecticut. Then I worked for the National Confederation of Business. Then I went to work for Senator Bill Armstrong, a Republican from Colorado.

So I have covered the whole philosophical territory from different sections of the country. I prefer to look at issues from a 360 degree angle. I worked for the AMA advocacy group for 18 years, so I understand the physician perspective. I was in charge of the AMA Washington office, as well as some of the Chicago office.

Q: In March, the health bill, The Patient Protection and Affordability Act, passed. It will roll out over the next ten years. Sixty percent of Americans view it with skepticism Physicians are anxious about health reform. They do not think they have had a central voice in shaping the legislation. Do you agree that politicians have marginalized doctors in this effort?

A: I do. You are right on. It has been an amazing and tortuous process. It is legally guaranteed we are going to have a decade of disruption for physicians in their practices. Frankly, that would be the case no matter who was president or who controlled Congress. It will disrupt physician-patient relations. There is no doubt about that.

Q: How can physicians better contribute to this reform? What constructive measures can we take to make this a better system and to help shape this debate, which will continue for ten years?

A: One positive development is the large number of physicians running for Congress. What we desperately need in these distinguished legislative chambers is more doctors. That we have so many doctors running, 47 in all, symbolizes physician reaction to reform.

The last time I counted there were 106 specialty societies, and most have political action committees. I highly recommend physicians get involved in those committees.
Q: One hundred and six political action committees. That’s physician fragmentation in action.

A: That’s why the AMA needs to exist. The reality is that we need the AMA no matter what the AMA membership is or what it purported to be. In one way or another, 99% of medicine is represented in these various physician organizations. It is not necessary fragmentation. It is democracy at work. Everybody ought to go see how the AMA House of Delegates works. It is a very democratic process, messy at times, but democratic.

Forty seven physicians, 41 Republicans and 6 Democrats, are running for the House and Senate this year. That is nearly 3 times the number of physicians serving in Congress today. Physicians start with at least one political advantage – voter confidence. If you looked at a Gallup poll in March, you would have found 77% of Americans trust doctors compared to 23% who trust incumbent Representatives and Senators.

Q: So?

A: So physicians need to get involved. I left the AMA five years ago, but , as a participant in Washington politics, I have watched first hand the toxic political environment of health care for decades. The thing that has always amazed me is how naïve politicians are about health care and how little they understand about health care.

For better or worse, what has occurred in this last “episode,” what I like to call the health reform bill, is that a great many politicians learned a great deal more about health care. The sad thing, of course, is that you still have too many policymakers who do not understand, yet they are making crucial decisions that impact the physician-patient relationship.

Q: Give me an example.

Q: Electronic medical records- a hot issue right now. EMRS have huge implications for practices. Yet have policymaker really seriously considered how much it will cost to transcribe old records? Will these new records improve care? Will they save money? No one knows, but EMRs will impact every physician in this country. That is why, over the course of a decade, you will see many different mid-course corrections as realities dawn of the consequences of sweeping health reform.

Q: Any other cautionary comments?

A: Beware of the “invisible government.” This massive legislation will lead to new rules and regulations, the magnitude of which we are barely aware. No one knows how these rules and regulations will come down. Most physician organizations are just beginning to focus on the “second wave” – the new regulations that are just surfacing.

To be honest, I am not a big fan of big government. If you’re talking about this huge new piece of legislation, you’re talking about more than 100 new commissions and advisory boards. On my side, this is about intruding on medicine. On the other side, they would say it’s about improving and controlling care.

Let’s look at a couple of the huge new bureaucratic entanglements. Right now, we have the SGR issue of how much you’re going to pay doctors. Later, because the House and Senate bills, didn’t take care of extended Medicaid funding, that will come back to haunt us. Then we will have all of these unfunded mandates. Washington is requiring states to do something about these mandates, but the federal government is not funding the mandates. The governors are very unhappy because they are being told to do something for which they have no money.

Now they are talking about the physician payment issue being settled by the Debt Commission President Obama just named. Congress is hoping the Commission will take a hot potato off their plate - how to pay doctors. If that was not enough, you’ve got the Medicaid Payment Commission, which has just been launched. Then there is the Medicare version of that Commission, which is called the Independent Payment Advisory Board, which is supposed to address Medicare solvency.

I have just mentioned three Big Commissions. Imagine adding another 100. That’s what we are facing in Medicine.

Q: I like your term “Invisible Government.” You seem to be saying dealing with Big Government is like dealing with a Huge Phantom Octopus whose tentacles reach everywhere and wrap us all within their grasp.

A: Yes, and that is why most medical organizations have armies of lawyers to grapple with the Monster. The worst thing about these multi-armed and multi-layered bureaucracy is that it is does not run for election. Bureaucrats are there for the long haul, and they all have their own fixed and deep philosophical opinions. Their beliefs often run contrary to those of physicians and patients.

Q: Let me ask you three other questions.

One, yesterday, the Obama administration announced it will spend $125 million to “sell” health reform, even though the reform horse has already left the barn. Do you have any thoughts about the chances for success of this effort?

A: The public has made up its mind. This initiative is a propaganda campaign, or as the administration would say, it is providing consumer information. My guess is that this “information” will not move the public opinion needle at all. Patients are pretty smart. They look upon how it impacts them, and how it changes their relationship with their physician. In most of their minds, Obamacare is not a positive.

Q: The second question is: What happens in November should the Republicans take back the House?

A: If you want a brutally honest opinion, it will have no impact. Obama will still be President, and he will have veto power over anything and everything. He has drive, energy, and commitment to this issue. This is his issue, and he does not want anything to happen to it. You need 2/3 of the vote to overturn a veto.

Republicans will never have that, and it will be very hard to undo what has been done. What you are going to see is a series of minor course corrections, with maybe even some major course corrections, but there will be no repeal and replacement. Most things don’t happen until 2014. We have time to think about what can be done.
Q; What can the Physicians Foundation, which represents physicians in state medical societies, do to shape policy and to mobilize their members to make positive contributions?

A: The Physicians Foundation is already is doing the right thing –educating their members and the public to what’s at stake here. It is doing what it can to help physicians and patients deal with the consequences of this legislative act. What The Physicians Foundation can do is translate, transform, and recommend what to do when operating in an unfriendly political environment. That requires educating policymakers, physicians, and the public about the far reaching implications of this bill.

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