by Courtenay Dusenbury

o many observers, partisan debates in Congress are hardly worth listening to. A doctor who has just finished 14 hours in the ER or a nurse facing double shifts in the pediatric oncology ward may find the endless rhetoric, finger-pointing, and name-calling to be completely unrelated to the real-life concerns of their patients.

Executives trying to balance the bottom line - facing future Medicare payment reductions with an uneasy eye - may find the news that Congress is considering even more cuts incomprehensible, given the shaky state of America's health care infrastructure.

Yet getting involved in the political process - becoming informed and taking action - is the only way to ensure that Washington doesn't enact policies that hurt our patients and our pocketbooks. Rest assured that while you are going about your health care-related business, Congress is finding ways to create new Medicare policies that may not always be helpful to you.

Like everything else in Washington, making Medicare policy is a lively spectacle, sometimes contentious and sometimes comical, that involves a complicated recipe of old friendships, party loyalties, campaign supporters, favors owed, and election-year surprises. The ultimate prize: control of the House, Senate, and White House.

These ingredients, perhaps more than the real needs of our health care system, influence what will happen in Congress this year. And key to this mixture is you, the constituent. Because your vote is needed, your voice makes a difference.

Medicare is the only federal program so micromanaged by Congress that payment rates for individual services are set by committee rather than by market forces. The House Ways and Means and Senate Finance committees control payment rates for even the most obscure procedure. For example, in 1996, members spent months debating the efficacy of the barium enema versus the colonoscopy, with both sides producing manufacturers, analysts, health care providers, and patients to boost their arguments -- and spending hundreds of thousands of dollars in the process.

Payments for Medicare services are only by a great stretch of the imagination linked to reality. Congress uses data provided by its Medicare Payment Advisory Committee (MedPac), a nonpartisan research organization, to come up with proposed policy. This data tends to be at least one and usually two years old and does not reflect current business cycles. Furthermore, MedPac considers the fiscal health of hospitals and other Medicare providers in a vacuum. Losses from other business - managed care, charity care, the uninsured, and the increased cost of non-Medicare supplies and labor - are not figured into the bottom line.

In 1997, Congress passed the Balanced Budget Act (BBA), which contained serious cuts in Medicare payments to teaching and community hospitals, physicians, home health agencies, nursing homes, and other providers. Congress has been trying to tinker with the adverse effects of this legislation ever since. Legislation passed in 1999 somewhat alleviated the problem for the short term but left the BBA's long-term cuts in place.

All of which brings us to 2002, when an unfortunate confluence of factors - a stalling economy, increasing prescription drug prices, a growing number of uninsured persons, cuts in payments from managed care, huge increases in medical malpractice insurance, and a workforce shortage - are being further exacerbated by more cuts planned for Medicare.

According to Emory Healthcare executives, these cuts will mean more than $4.2 million in losses to the hospitals, including lower indirect and direct medical education payments and $2.6 million less to The Emory Clinic in physician payments. That's just the first year. The lowered payment baseline means Medicare payments will continue to drop relative to inflation at a time when every other cost is rising.

It's time for all of us, even the most Congress-phobic, to take action. A simple letter to your senator and congressperson will do. There's plenty of legislation out there to support, including the American Hospital Preservation Act (H.R. 1556/S. 839), which would restore proposed cuts to hospitals and teaching hospitals, as well as legislation to reinstate cuts to physicians and other providers. Also worth your support is the Teaching Hospital Preservation Act (S. 2447), which specifically addresses looming cuts to indirect medical education payments. The Medicare Physician Payment Fairness Act (H.R. 3351/S. 1707) would eliminate most proposed cuts in physician payments and create a more accurate methodology for annual updates.

Our website contains draft letters that you may cut and paste as well as the names and addresses of our legislators. Please take a moment or two to send a letter to one or more of our elected officials to let them know that you are concerned about America's health care infrastructure.

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A simple letter - thoughtful and concise - will make a difference. This direct communication with your elected officials is a far cry from the political bombast we see on CSPAN every evening. Yet each letter is read and responded to, and when members of Congress start getting 30 or 40 or 100 letters, they begin to pay attention.

We all have at hand the means to get involved in the political process. Please consider taking five minutes this month to help shape what happens in Washington this year.

Momentum welcomes your submissions to "On Point." If you are interested in exploring an issue vital to the well-being of our mission and the people we serve, send your idea to Momentum, 1440 Clifton Road, Suite 105, Atlanta, GA 30322; call 404-727-8793; or e-mail mgoldma@emory.edu.