The Dirksen Building was built in the 1950s at a time when cost constraints precluded the incorporation of expensive ornaments or grand interiors into the construction plans. The building’s stone exterior façade, alternating with multistory dark window columns, suggests an ornate interior. This prediction is quickly dispelled: upon entering through the heavy bronze doors situated at the building’s corners and walking into the exceedingly small and simple lobby, I was reminded of the generic medical office building that many of us inhabit. Perhaps the most striking aspect of the Dirksen’s design is its long hallway corridors that are bare except for the occasional cluster of flags that mark the entrance to a senator’s office suite. Once inside, the visitor is told to sit in a waiting room whose walls are adorned by an array of sports-related memorabilia. There are photos and newspaper clippings depicting winning goals and Super Bowl touchdowns or other iconic items, such as autographed team jerseys. On mahogany desktops, I noticed many signed baseballs, basketballs, and hockey pucks. It must be fun representing a region like Boston with so many championship teams! Invariably, there is the requisite photograph of the politician shaking hands and/or sharing a joke with a recent president; in general, that president is Ronald Reagan if the politician is a Republican and Bill Clinton if said politician is a Democrat.
At each office, we were greeted by the perpetually smiling, well-caffeinated, friendly young staffers. These legislative aides (LAs) are a very devoted bunch. They reminded me of their medical peers, the hardworking residents and fellows that we have the privilege of working with every day. They are cut from the same cloth, except they probably chose not to major in pre-med studies in college. Both groups are of similar age, smart, upbeat, hardworking people who are poorly paid for their efforts. Since they work in Congress, I doubt that work-hour rules apply to them. No matter, they seem to thrive on the arcane minutia of the legislative process.
Fixing the SGR
During our limited time with the staffers, we raised the thorny issue of how to fix the Medicare Sustainable Growth Rate (SGR) in a way that recognizes the value of our professional services to our patients. The SGR is essentially an equation that was created in 1997 as a way for Medicare to control rising physician fees. It tries to ensure that the yearly increase in the federal expense per Medicare beneficiary does not exceed the growth in the Gross Domestic Product (GDP). However, the methodology behind SGR is considered by many observers to be highly suspect.