I spent an exciting three days in Washington DC with approximately 150 surgeons from the other state chapters. The first day was a program dedicated to devolving leadership skills, embracing change, and being a driver of change and a leader in the local arena. Dr. Tom Russell, Executive Director of the ACS then ran an open forum discussion with us and fielded a wide range of questions. The second day was dedicated to informing participants on a number of important issues such as liability reform, the care of under/un insured patients, medicare, and private insurance issues.

The session started with the Dr. Shoshanna Sofaer, author of an Institute of Medicine report ,on the economic and health consequences of uninsurance and proposed plans to eliminate the problem. This was followed by a panel presentation and discussion on the new application of quality measures in selection and payment of health plans. The panelists included Dr. S Jencks the director of the Quality Improvement Group at the Centers for Medicare and Medicaid, Gerry Shea from AFL-CIO to represent employees requirements, Dr. Korn, Chief Medical Officer of Blue Cross and Blue Shield, and Helen Darling President of the National Business Group on Health representing many large employers. The message of this forum was that increasingly quality measures were going to be used in decisions about payment and choice of health care plans for employees. The remainder of the day was spent specifically on how to understand and influence the legislative process. Ms. Nickels a Congressional Scholar gave the best explanation I have ever heard on how bills move from the house and the senate and why our current senatorial makeup is proving disastrous for getting any bills through the Senate. She also highlighted techniques for how "regular" people like all of us can get their voices heard. She strongly encouraged participants to make sure to speak to their representatives at their home office, bring a personal story about the issue, and any local data that would be relevant. She then suggested follow up meetings as new information is available to keep your issues current in their minds. Lastly we were briefed on the three main issues we were to discuss in our visits with our local representatives the next day. The briefings were on medical liability reform, Medicare unbundling of physician administered drugs from billing that to all doctor fees by shifting the drugs to the pharmacy budget, and re appropriation of money for trauma care.

The last day I spent visiting the offices of Senator Diane Feinstein and Representative Anna Eshoo. I discussed all three of the issues with their medical affairs legislative aids. I am somewhat encouraged to see the Senator willing to engage in conversation about liability reform but she strongly insists on a larger cap on non-economic damages, more in the range of $500,000. It was also expressed that she would only get behind this issue if the California Medical Association comes up with a proposal she can support. Her office gave me a pass so I could go to the Senate gallery and watch them al at work. Both of California Senators were on the floor working as were many recognizable and famous faces. I left the Senate to return for a debriefings with the ACS staff about our visits and the content of the conversations and then returned home. I was very impressed with the quality of the experience. I had never had the legislative process explained so cogently with tools given to help influence it. I applaud the ACS in their effort to involve us and speak for all of us in these measure. I definitely got my checkbook out to donate to the PAC so surgical voices are heard amongst the din of all the others. The ACS Washington DC office is open to all who are in town, I highly encourage all members to visit.

Sherry M. Wren M.D.,FACS