Bill Klaproth (Host): This is AAOMS On the Go. I'm Bill Klaproth, and I am pleased to welcome with me today Congressman Rich McCormick. Congressman McCormick has represented the state of Georgia in Congress for the past two and a half years. He is also an emergency physician on top of that, spent 16 years as a pilot in the Marines, and another four years as an emergency medicine physician in Kandahar. The man does it all. So we're very excited to talk with Congressman McCormick today. So he brings a unique perspective for OMSs, both as a healthcare provider and as a legislator. Congressman McCormick, thank you so much for your time today.

Congressman Rich McCormick: Hey, it is great to be with you. I will tell you some of my closest colleagues are in your specialty. I love this. It's fascinating, first of all, and also very germane to our discussion today as a big part of healthcare.

Host: Well, thank you for saying that, and you being an emergency room physician certainly know what surgeons and other people in the medical field go through. So that's why we're very interested in talking with you today. So obviously, you hold a unique perspective as a healthcare provider and federal legislator. So, Congressman McCormick, based on your experience on both sides of the equation, if you will, what would you like the OMS community to know about the legislative process and how best to communicate with legislators?

Congressman Rich McCormick: Sure. Well, first of all, realize that if you're not at the table, you're on the menu. The whole reason I got into politics is because I went down to the Georgia State Capitol as an emergency medicine physician on what's called White Coat Day. We were fighting for a solution to surprise billing. It was our second year. The first year, we'd failed. The second year, we go down there. And I always thought politics is pretty straightforward. I've never been to a political meeting in my life, never been to a fundraiser, didn't know any politicians. Went down there with a bunch of people in a bipartisan fashion to solve a very real problem, thinking, “This is a slam dunk.” We have patient advocacy backing us, and this will be an easy fix because we have a very common-sense approach that was well thought out, very reasonable. And it was one of the people in my party who was representing special interest, who had a competing bill who wouldn't give us a fair shake in the hearings. And it upset me. First of all, we got nothing done that year. And it took us three years to pass anything in Georgia. And of course, the very next year, they passed something on the federal level, which has been absolutely abused, which is typical of bureaucracies and administrations that don't agree with you. But it was such an eye-opening experience because I was so angry. At lunch, they're like, "Well, if you're that angry, why don't you run for office?" I'm like, "Well, how do you do that? I have no idea." I got involved with some people they set me up with. Fired everybody after about three months, started over. Went against my state senator who hadn't lost in 33 years, had been a mayor, had been a rep, had been a senator, had a million dollars in the bank, was endorsed by 11 of 12 mayors. And we whooped her by 40 points and the rest is history, as they say.

But what I'll say is this, what I found in this, the people who have been most involved have had the most benefit. Now, we're still getting abused, still getting cuts in reimbursements from the government and went down by, I think, what 2.8% last year. Picked on physicians specifically, not hospital systems, only physicians, which is of course bringing everybody into a single-payer system or one-hospital system, which is typically, you know, "Oh yeah, okay. You saved 2.8% this year." But the hospital system that you're forced and sent to costs 30% more. Not a good idea, not well thought out when politicians make these one-time passes with unintended consequences. We have to lobby hard to educate all the physicians, even with physicians in Congress. There's only about 14 of us that actually are participating in the doctor's caucus. They're all Republicans.

Now, we know that physicians have taken about 30% hit in reimbursements when averaged over the last couple decades when adjusted for inflation. Meanwhile, health insurance and premiums have become 30% more expensive. So, if everybody's paying more and the government's paying way more, and it's a $5 trillion industry and the biggest spending item in government, biggest spending item out of people's pockets, whether it be your taxes or your personal. Why is it increasing so rapidly and why haven't we done anything about it? Well, because it's a $5 trillion industry. That means that four of the top 10 Fortune 500 companies in America, some of the top 20 are insurance companies. Big problem. And they're integrated with the government now.

So, no matter what we do, it's the worst of all systems. Because even if it's government run, it's still insurance industry that's driving the train. And then, add PBMs to that and pharmaceuticals to that, you have three of the most powerful lobbyists groups in America all right here. We actually had a PBM fix back in December, and it was taken out because Elon thought it was too much work. And I'm not against Elon, by the way. I like the guy. He's brilliant, but he doesn't always understand the ramifications of politics.

So, all that to say that being at the table is really important. Lobbying is very important. Being involved protects your coding, protects your reimbursements. The orthopedics, for example, have been one of the most involved in politicals, even if they're probably one of the most protected when it comes to having their own hospital systems, having their own payment schedules to remain more independent, less reliant on the hospital systems, less monopolized. They've done a better job because they're more politically involved. Being involved politically is very important and that's a sacrifice, don't get me wrong.

Now, you say, "Well, I don't want to pay somebody to lobby for me. I don't want to have to do a fund. I don't want to try to get some politician. They should be doing the right thing." Just remember, there's a lot of competing values with you that are involved, that you're trying to educate us. And if you're not involved, you're leaving it to fate and it doesn't result well because the two people who've been punished the most in medicine have been the most instrumental in what needs to be done. In other words, the patient which pays more and the physician who gets paid less. Everybody else is benefiting off us in an industry that literally by itself would be the third largest economy in the world. And there you have it. Get involved.

Host: Right. Yes. As you said, if you don't have a seat at the table, you're on the menu. So, that's very important. And as you said, lobbying, very, very important, especially for OMSs and the specialty, to make sure that we're being represented and our voices are heard in Congress and in the government. So when someone comes to you, Congressman, to you and your colleagues, what do you want to hear from providers? What message are you looking for us to tell you?

Congressman Rich McCormick: Well, here's the dirty little secret. If you come at it and you say, "This is bad for me," nobody cares. Physicians are a very small portion of this community, and we're not good donors anymore, because we don't have the discretionary income that we used to have because you make 30% less. The average physician does.

Now, OMFS surgeons make still pretty darn good money. And I made pretty good money as an ER doc, but it was decreasing every year. Now, ER docs probably have taken a 20% hit in the last five, 10 years alone. We lost all our independence. OMF surgeons are right behind us. Everybody's taking a hit. And even though you make more money, you're not feeling like you should donate when you're losing money. It makes no sense. But when you start to look at how we're talking about lobbying efforts, if you come at it and you say, "Hey, this is hurt. I'm good. Why am I getting punished?"

Now, I agree. And I think it's a problem and I think the prestige of our profession, our ability to live at a certain level that we expected after we paid however much money to get through medical school and residency and the sacrifices we made, but nobody else cares, guess what? And there's only 14 involved physicians and there's about 177 lawyers. So you do the math on that. So, how do I sell my product? We got to talk about what's good for the patient, because everybody's a patient. Even we're patients. And the American people, collectively, that's 330 votes instead of 14 members of Congress.

So, what does that mean? I have to be able to explain to people why when you cut my reimbursements, it forces me into a hospital system that's way more expensive, it's going to cost you way more money. Plus, every time you have a site neutrality issue or pre-approval process or anything like that, which causes us paperwork and hassles, it makes our job very difficult to do, it's bad for the patient. It's bad for patient outcome, it's frustrating for a patient. So if you come at this for what's good for the patient, whether it be cost effectiveness, long-term savings, access, and just lower stress point, then it's a good selling point.

Now, I'm just giving you an angle of how we lobby, because you're going to have to sell it to largely 435 people. You have to get the majority of 435 people to agree that what you're trying to lobby for is important. So it can't be about doctors because nobody cares about doctors. I hate to say that. I love doctors, and it's super important, we're still a respected community, but we're losing all our power. I think there's a reason we go into this profession. It's to serve, it's to see an outcome that we really like. I don't mind making money either. But we have lost all of our leverage when we make it about ourselves. So, when you're trying to sell something, make it about the patient, what makes sense, what has access, what's good for the future of medicine, and we win.

Host: Yeah, that really puts it in perspective, as you say. If you say, "It's bad for me," no one cares. So, when you come in, make sure you talk about the patients and what's good for them.

I know you and your fellow legislators are on a tight schedule with multiple meetings and votes in any given day. Very busy. Any advice on how providers should deliver their messages, what they should bring to the meeting, and how should they deliver this in a short amount of time? How can they be most effective when they're meeting with you?

Congressman Rich McCormick: Well, when you talk about effectiveness, first of all, having a relationship with your congressman is effective because they'll respect you because you're a physician. You're a leader in the community, you're an influencer, but especially, if you're involved in their campaign. I mean, now you have my ear and now you can actually get ahold of me and you have my phone number and you're actually educating me. Because most Congressmen, even if you're a physician, don't have a good grasp on the business side. Because let's face it, I think well over 70% of physicians now belong to a hospital system. So, that's not most OMFS surgeons, but the majority of physicians are already part of the problem now, not because they want to be, but because that's the way the system's designed.

It's going to be very hard for us to divest from that system, because all the power is held by the monopolies. And so, we've been basically – how should I say? We've been squeezed out. We've lost our lobbying ability. So that's the only power we have, is to appeal to people to do what's right. The only way you do that is having personal relationships so you have an authentic, genuine relationship and a good discussion with somebody as an educator. So that politician can do the right thing. Because most politicians, believe it or not, do want to do the right thing, but it requires a relationship. It requires involvement and, at times, most of us don't feel like we have.

Host: When it comes to the meeting, so they come in, we schedule with your staff, we come in to meet you, what do you want to hear? What should we have prepared and how can we be most respectful of your time?

Congressman Rich McCormick: Well, you'll generally only have anywhere from 10 to 30 minutes at most. Thirty minutes, that means there's a group of you and you're really important, maybe you're big supporters. And when you're supporters, people pay more attention. I'm just telling you, because I don't want to disappoint you. I don't want to lose my ability to get reelected. That's my power. If I can't get reelected, I have no power. If I'm going to retire, I have no power. You know, people want to look at the future. You're a stock. And when you invest in stock, it's because you want to have something on the rise. And so, that's how politicians look at things.

Now, as a physician, they look at you, some of them very transactionally, right? So, what can you do for me? But almost all politicians also want to do what's good for the community because that benefits, that's something I can talk about, that's something I can sell. So whatever you tell me is something I have to sell to the public. Defend my vote, defend my legislation.

Some people actually come – the best prepared people come with, "This is the legislation we think you should pass." It means you've already designed legislation that you can actually sell to the body of voters, both Democrats and Republicans, because usually you don't have a super majority. And then, something you can actually show the benefit to the society, not just docs, but to society, whether it be approval, preapproval process, protecting nurses or protecting the price point. Making it more affordable, making it more accessible, making it more streamlined. All those things to say that if you can sell it as the right thing to do and you have prepared legislation that we can modify maybe slightly, that is the best possible way to get something. Because now, I don't have to design a bill around what you want. You've already helped me write the bill and you've already thought this out. That is the prime.

Now, most people don't make it that far. Let's do the next step down. You show up, you have an idea. Look, if you don't give me a pre-approval process, I'm fighting, or if you don't give me my reimbursement, I'm constantly trying to go back for 40% of my denials of all billing, I have to go back and that's administrative cost. That's 25% of my cost. You're costing the taxpayer – you're costing the average person who pays an insurance premium – money. How dare you? Now, I have something to attack, at least to make legislation to counter that. If you say, "Hey, look, I can't afford to be open. I'm going to have to go into the hospital system.” That's going to cost you 30% more. How do we preclude that? But I have to be creative enough. Most people who are not physicians or don't have a healthcare background, which is probably 99% of all congressmen, aren't going to know what to do legislatively. So, once again, put yourself in an advantageous position to at least join forces with maybe Congressman McCormick or somebody else who has legislation, somebody in the doctor's caucus, which like I said, about 14 active members. But back those people because they're the ones that need to be bringing this to the table.

We just had a meeting last week where we had us. And by the way, to give you an idea of the power, six members of the SALT Caucus just cost us about $300 billion, maybe $400 billion in the next 10 years, because they collectively would not vote for the Big Beautiful Bill unless you gave them that SALT package. So, imagine what 14 doctors can do if we draw a line of sand. We met last week, and this is something I've been pushing the doctor's caucus real hard on. Stop meeting with everybody else. Let's talk internally. We have 127 pieces of legislation in the doctor's caucus. That's ridiculous. We have more pieces of legislation than we have Congressmen, over 435 pieces of legislation on healthcare. Nobody's going to consider all those. Let's pick the top three. Coalesce behind that and tell the speaker, "If you want to pass the CR or whatever you're going to pass next, you have to pass this too." That's a tremendous amount of power. Know who you're backing, know the tactics, know the strategy, and pick your horse. But you have to pick somebody who can represent your interests, not just for your benefit, but for the benefit of all Americans.

Host: Yep, that makes sense and some really good points, Congressman. Come in with legislation prepared. That helps you immensely. Show the benefit, the price point, et cetera. So, those are really good points.

Congressman Rich McCormick: And you can also join forces with other specialties too, and we're pretty good about that in D.C. Because it's hard to stand as just a surgeon. But if you collectively bring the different healthcare industries together… sorry that’s the wrong way to put it – the healthcare specialties together, you do have a lot more leverage.

Host: So if someone comes in with a personal story or an antidote in that 15- to 30-minute meeting, if you will, does that help? Do you want to hear personal stories or anecdotes?

Congressman Rich McCormick: It helps draw the picture, especially if you can say – if you can scale that out. "This is my experience. Everybody's going through this.” But even more effective, “This is my patient's experience. Everybody's going through this.” Now, you've scaled it out big time, right?

When we talk about, like, for example, a price point. We have a built-in harassment system. I write a script for a patient. They go to fill the script at the nearest pharmacy, not thinking anything of it because they're used to using their insurance company, right? We've been trained. I’m going to get that, I'll pay my copay. Let's say – I'm going to simplify math for a second – Let's say it's a $100 prescription for Augmentin, which is dirt cheap. But we go to the pharmacy, we pay our $10 copay, we get our prescription. It actually costs about 80 bucks is what they're going to charge your insurance company. These are rough numbers by the way. Then, they get a 10% upcharge on that because they're allowed to by law to cost average amongst the premiums. So you just pay $10 copay plus $90 through your insurance company. And so, you paid a hundred dollars for Augmentin. And if you would've paid out of pocket, it would've been about 10 bucks. You see how we've been trained for the self-licking ice cream cone, where there's a built-in profiteering because we've been trained to do that.

Imagine if everybody used their car insurance to change their car oil. You know how expensive that would be? It'd be several hundred dollars and there'd be no price point. It would just keep on going up every year automatically. That's why LASIK eye surgery, which is elective, is cheaper than it was 30 years ago and better. Because it's competitive. But if it was required by your insurance companies because of a government mandate, it would be probably $5,000 an eye. See what I'm saying? Instead of $800 per eye. This is why competition drives better pricing. Insurance companies make a boatload off of expensive medicine, because they just take a percentage. And this is why the biggest companies in America are insurance companies followed by PBMs and pharmaceuticals. Because it's a built-in system that we've been trained to pay into collectively.

Host: Yep, that's right. And I just want to say the self-licking ice cream cone, that's very interesting. That really paints the picture.

So, I also want to ask you, are there mistakes that people make when they come to see you after they leave? Are you like, "Man, this person really wasted my time. They should have been prepared. They should have come with this, this, and this." Are there mistakes that you see that we can avoid?

Congressman Rich McCormick: Well, one of them I already mentioned. Don't make it just about yourself. I get it. If you've been abused by the government, by the way, that's a separate issue. Collectively selling the problem and having a solution. There’s people if you go to a church and you say, "Hey, we should do this better." The minister's probably going to turn to you and say, "Okay, you're in charge of that." Right? Because they don't have enough time for 500 different complaints and to try to figure out what to do. Have a solution. Be part of the solution. Have an idea of what's realistically being able to be accomplished. There's certain things we're so far down the road on, I don't see a near term fix. Until I'm president of the United States, I’m sorry. I'm just not going be able to have that solution and push it through Congress because I have to sell the majority of 435 in Congress and 60 most likely in the Senate. And that's going to be a mixed both Democrats and Republicans, and then have the president sign. You know, the perfect storm to change anything in healthcare, it has to either be part of an omnibus or a very, very well-written bill that everybody knows is good.

Host: So, Congressman, you were mentioning earlier the value of relationships. Do you have any tips for building those long-term relationships? And I know your staff and legislative staffs are very important in this process, especially when it comes to making the appointment, getting in there, promoting issues, et cetera. Any tips for building long-term relationships with legislators and their staffs?

Congressman Rich McCormick: Yeah. So first of all, pick your horse, right? It doesn't have to be a horse in your stable. In other words, it doesn't have to be your representative. But you got to have somebody who rides, you know, somebody who's going to be out there and actually active, somebody who's submitting legislation. Four hundred thirty-five of us up here. We're top 12 of those legislators. There's some people who are in the bottom 12. Don't pick people who are not active. Don't pick people who will not get involved, who will not write legislation, who will not champion, who will not work the crowd to pass things. There's a lot of people who are show horses out here who get a ton of media attention, get a ton of donations, and get nothing done. It's embarrassing. So be careful who you think is actually effective. Just because they're popular or famous doesn't make them effective at all. It may sound great to have somebody champion you, but if you're just out there rattling cages, it doesn't mean you are actually benefiting from that. Know who your friends are. Know who's actually going to go to bat for you. That long-term relationship, once again, building that relationship by investing, going to see them there in their D.C. office or their local office or investing in their campaign saying, "Hey, I want to get you reelected. I'm going to invest. Because I care about you. I would like to have a seat at the table. I'd like to be able to bend your ear occasionally. Would you mind doing that?" You know, that's a relationship, and it is not quid pro quo, by the way. It's me saying, "I want to have a relationship with you where I can actually make my case to you, and I want to sell you this product I think is good for all Americans." That's how you do it.

Host: Another question is – follow-up is key from these meetings – how can providers effectively follow up after meeting with a legislator or their staff?

Congressman Rich McCormick: So, that's the accountability piece. That's just like when I assign something to my legislative team, having an idea is great. But as Elon Musk told me the first time I met him, before he was into politics, somebody asked him, "Hey, what's your next big idea?" Now, I'm going to write this down because this is the richest guy in the world. He says, "Well, to be honest with you, I have a million ideas. I can't go to sleep at night because I have so many ideas. But the question is not what my idea is, but what can I actually execute?” That's a big difference. There are tons of people with ideas in Congress, that are great ideas, and I wish I could do – like, for example, a fair tax. The tax system is way too complex, way too convoluted. It's way too full of lobbyists and special interests and way over-bloated bureaucracy. I would love to fix all that, but I realized I'm not even anywhere close to getting it done. So, I'm not going to waste my time on that legislation. So, pick your fights, right? Make sure it's something you can actually execute. Make sure it's somebody who will actually do the work.

So when I talk to my legislative team, I have to follow up and say, "Okay, why haven't we done this?" "Well, sir, we tried, but nobody's biting at it." Nobody likes that wording, or somebody has a competing bill, blah, blah. I need to know the facts. I usually follow up – you know… If you follow up too soon, people stop listening to you, because you just become annoying, right? But if you're a reasonable person, every month or so, you say, "Hey, how are we doing on that bill?" And it's not a lecture. It's like, "How are we doing on that bill?" I should be able to give you good feedback. "Let me check. Let me get back to you." I should tell you where it's at – whether the doctor's caucus or the legislative branch, whatever it is – to give you feedback. Now, if that person's regular stalling and doesn't have any answers, that's not your horse. Time to divest and move on. But the most of us who take this very seriously will have some answers to that, and that's what you do. You basically say, "Where are we on that bill? Did we write that legislation? Who's got it in their hand? What's the hold up? How can I help?" That’s helpful.

Host: Yep. So, it's certainly okay to follow up, ask, inquire, "Hey, where is the bill at?" No problem at all. But you certainly don't want to be annoying and bug. But certainly good to follow up and ask where things are at.

So, earlier you were talking about some in Congress are in it for show. They don't really get a lot done. You mentioned you don't even have to go to your own representative. So, if I'm in a district where my congress person is one of these persons that doesn't get a lot done, you're saying it's okay to go to another representative in my state that's not in my district. You're saying that's okay. So, if somebody comes to you that's not in your district, it sounds like you still want to hear from that person?

Congressman Rich McCormick: I'll actually go an next extra step. Most of you won't have a representative that are good at healthcare. It’s just because most of them are uninformed. That's one of the most complex expensive systems in the whole world. Most physicians don't even understand the billing process, the government's play in that, because they're busy just being good doctors. You know, good luck. And you're lucky if you have your own business as a doctor, you're in the top 20%, right? Or maybe not top percent in income, but a rare portion of doctors actually have their own business. Most of it is run by hospital systems, so you don't even know how that's billing. You just know a bunch of administrators do. You submit your paperwork, they harass you, and eventually you get paid. It's all magic, right? You get into Congress, and all of a sudden you have to learn about all the minutia. It's like, “Oh my gosh, it's overwhelming.” So complex. So once again, going to a person who's an expert, which there's only about 14 of us out of 435, chances are you don't have one of those. So, you very much have to go not only out of your district, but a lot of times out of your state, quite frankly. And so, and then once again, there's even more effective people inside that 14. Some people are much more elite than others. Some people are much more powerful than others, just based on position and time and all that stuff.

But once again, you can get involved in anybody's campaign. You can get involved with anybody's life, but you have to put in the work. That requires – if it's not your congressman – that requires either a trip to D.C. or you have to track that person down through their campaign. Because good luck, if you call here and say, "I want to talk to the congressman from a different district,” good luck. I got enough people trying to do that as it is. But if you want to get involved with me personally, it requires an investment.

Host: So, like anything, it takes work. Work on building that relationship. Potentially, work on the campaign. Support is very important. That is one of the best ways to start to build that relationship. That's what it sounds like. And if you do that and do the things like you talked about, all those things that you want to hear, all those tips that you gave us, that's the best way to get in there and then have your message heard then.

Congressman Rich McCormick: Yep. And that's your best chance. Everything's a percentage, right? When you treat a patient – doctors will appreciate this – when you treat a patient, you do the standard treatments, whatever that is. That gives you your best chance of success. It doesn't mean you're going to be successful. You're going to have infections even though you did everything right. You're going to choose the wrong antibiotic with maybe resistance to some sort of bacteria, because they just had that bacteria in them. Everything's a percentage. Medications work differently on different people. That's why we do genetic testing.

Same thing in politics. Everything's a percentage. The most effective politicians understand the best ways to pass things, and they work the system because there is some gaming involved in this. That's why I say relationships inside Congress are really important. How I treat people, how reasonable my legislation is. Is it uber political? Is it uber galvanizing? Am I a caustic person the way I present it? Or am I a salesman who actually can sell an idea because it's good for Americans and makes sense?

Host: Well, Congressman McCormick, I want to thank you so much for your time. This has really been fascinating. Before we go, one final question. Any thoughts on overall involvement and why it's important for legislators to hear from their constituents?

Congressman Rich McCormick: Yeah. Once again, there's powers in numbers. We hear from every industry, and I'm hearing about tariffs. I just got back from Korea, Cambodia, Thailand, talking to them about their economies, the tariffs, the impact on that. I got to consider military strategy, the way we interact with other – in foreign affairs. In science-based technology, the development of AI right now. Why am I saying all these things? Not to distract you from medicine, but we are distracted constantly in Congress by everything that's happening. Think about President Trump and how rapid, every day there's some new idea. I get on an interview with Fox or NewsNation or Newsmax or CNN and, right as I'm on there and they're like, "President Trump just said this five minutes ago." And you're like, "Ah." And so, that's the rapidity of this cycle of news. So we're constantly distracted.

It does require follow-up. It does require involvement. It does have to be a priority because, by the way, we are the most important fight in government right now. It is the biggest spending item in government. About two and a half trillion dollars of our $7 trillion budget – over 30% of our budget – is healthcare. And that doesn't count the other two and a half trillion that comes from the private industry. It is the biggest thing, not only in government, but to all Americans. And it's the fastest growing too.

This stuff matters. We have to make sure that we start with that point and that your involvement, it’s just got to be continuous. I know it sucks. It sucks, but quite frankly, any relationship – whether it be a friendship, family, whatever – is going to take time out of your lives. So, we know anybody who has kids or a spouse knows that is an investment that sometimes is not easy to do, but super important to the future.

Host: Very well said. Involvement has to be continuous. And you got to build those relationships, because that's ultimately where common ground will be seen. Or the message will get across and that legislation could get out there and then get passed, and that will help the OMS specialty, for sure.

Congressman McCormick, thank you so much for your time today. I really appreciate it.

Congressman Rich McCormick: My pleasure. We're one team, one fight, man. Semper Fi.

Host: I love that. Thank you again. And once again, that is Congressman Rich McCormick. To learn more and get involved in AAOMS’s advocacy efforts, visit AAOMS.org/Advocacy. And if you enjoyed this podcast, please share it on your social channels and make sure you subscribe so you don't miss an episode. I'm Bill Klaproth. This is AAOMS On the Go. Thanks for listening.