December 2011

Stupor Committee

By Michael J. Katin, MD

History has now recorded that on November 23, 2011, the members of the Congressional Committee for Debt Reduction (the Super committee) delivered a Thanksgiving present. Their recommendations will allow not just reduction of $1,300,000,000.00 in deficits over the next ten years but also a comprehensive revision of entitlement programs, permanent peace in the Middle East, determination of a unified theory of physics, and a rhyme for the word, "orange." The only unresolved item was the impending SGR reimbursement reduction, for which a solution could not be concluded.

Unfortunately, this is not the history of this country or even this planet, but of a planet 30 light years away. For the record, a light year is the equivalent of approximately 6 trillion miles, which is a number of miles not even 50% of the number of dollars in the National Debt. The United States was again subjected to the spectacle of politicians not being able to follow through with anything except having clandestine affairs or making money from insider trading. Certainly not the SGR fix.

A familiar quotation is that a camel is a horse designed by a committee, but it seems the Super committee may have been designed by a demented camel

For those who tuned out on this story weeks ago, the Super committee was made up of six Democrat and six Republicans, with half from the House of Representatives and half from the Senate. Was the thought that including as many as twelve people would make it too big to fail? It should have been obvious that this combination of individuals would be extremely unlikely to be able to come up with a consensus on spending reductions and taxation. In a masterpiece of poor judgment, the committee included the chair of the Democratic Senate Campaign Committeee, Patty Murray, and the previous chair of the Democratic Congressional Campaign Committee, Chris Van Hollen. Who would have expected any of these to have partisan considerations that might influence any decisions? In addition, several other members are in key leadership positions. Xavier Becerra is vice-chair of the Democratic House Caucus, James Clyburn is assistant Democratic leader in the House, Jon Kyl is Republican Senate Minority Whip (and former chair of the Republican Conference), and Jeb Hensarling is chair of the House Republican Conference, in addition to having the most outrageous toupee since James Traficant. Presumably, the argument was that persons in these leadership roles would have influence over the other members of Congress, but, again, when is partisanship able to be suspended? Despite the fact that there are 58 states, two of the members are Republican representatives from the same state, Michigan: Dave Camp and Fred Upton. Mr. Upton is distinguished both by his role in banning the incandescent light bulb (before trying to reinstate it when he became Chairman of the House Energy and Commerce Committee) and being the uncle of 2011's Rookie of the Year, Kate Upton . Senator Max Baucus has long been an eloquent statesman with the specific credential of having been a member of the Gang of Six. . Two members may have been too dedicated to holding down taxes to allow a balanced decision on deficit reduction. One of them, Senator Pat Toomey, is a past president of the Club for Growth . The other, Senator John Kerry, has been known to use innovative techniques to keep his own taxes to a minimum . The final member, Senator Rob Portman of Ohio, has an outstanding financial background. He was U. S. Trade Representative and then, on May 26, 2006, was confirmed as director of the Office of Management and Budget under President George W. Bush. He gave up that position on June 19, 2007, saying he wanted to “spend more time with his family”. The dominos of the 2008 economic collapse started to fall just as he was leaving office. Was his resignation a coincidence, prescience or self-preservation ?

It is no surprise that this collection of public servants was unable to come up with a solution, let along schedule regular meetings . The final result is that this group will go into history with the same fond remembrance as the Warren Commission , the Securities and Exchange Commission , the Joint Commission, and Marky Mark and the Funky Bunch .

Since it's all about us, what does the experience of the Super committee have to do with the field of Radiation Oncology? Just about everything. The intention was to determine a fair and balanced way to pay for the functions of government, while determining which government activities will need to be restricted. Unfortunately, support for medical care and research is always a target. Payment for oncology services is strongly oriented around Medicare allowances since many patients are Medicare beneficiaries, and private insurers tend to make decisions based on CMS policies. There is always the continuing risk of restriction of reimbursement or access resulting from draconian measures to balance the budget. There is also the risk of bundling, which will require “someone” to determine how a fixed amount is spent on treating a specific disease.

This then produces the specter of another Super committee being formed to determine treatment options and distribution of funds for treatment of each diagnosis. One could envision proactively setting up a committee made up of medical oncologists and radiation oncologists trying to come to a consensus, before the government does it for us. It would be simple if the committee also included surgical and gynecologic oncologists, since their substantially more powerful strength of will would dominate and make the meetings much shorter. Add to this the controversies between academic and real-life practitioners. Imagine assigning this group three months to decide once and for all the proper first, second, and third-line treatments for all diseases, let alone decisions on the use of partial breast irradiation, cytokines, proton beam therapy, bevacizumab, and induction chemotherapy for head and neck and lung cancer, to name but a few. Resolving these controversies could be even more difficult than those addressed by Senator Murray and associates.

There's no good answer, and the only thing we can do is go along one day at a time until life as we know it changes forever. We will wait for our government to make its decisions, with the knowledge that, when all is said and done, any government committee will have the same benevolent attitude toward the people it serves.