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We are at a considerable crossroads in medicine and cardiology. The Affordable Care Act may provide us with more coverage for needed preventive services and provide 35 million people with some form of healthcare coverage, but the overall ‘pie’ of healthcare dollars will be shrinking, in an attempt to forestall the failure of Medicare and the further debt spending of the US. A call for a balanced budget, pursued by both Republicans and Democrats, will undoubtably be the mantra of this election year and thereafter, and ‘prudent’ government spending will mean at least some form of containment (the ‘sustainable growth rate’ [SGR] Medicare physician payment formula) of healthcare expenditures. Thus, important advancements, such as those described in this edition of US Cardiology, may be hard to fund without matching cuts elsewhere. So far, we have avoided the SGR, which has been deferred year after year, but sooner or later it may be enacted, resulting in an immediate 27 % cut in Medicare physician fee reimbursements. Each year, the Congress has acted to ‘kick the can down the road’ and defer any decision related to enacting the SGR, but each year, the debt grows bigger and the cuts, if they come, will be harder to swallow. This last Congress deferred the SGR for only two months, so we are in a point of limbo as to whether there will be enactment or further deferral.

Articles in this edition of US Cardiology cover some of the most important advances in cardiology, and we cannot let dysfunction in Washington undo our progress. This edition discusses improvements in hypertension (including baroreflex sensitivity assessment), in implantable cardiac devices (that may very well further improve the management of arrhythmias and heart failure), in echocardiography for heart failure, and in the assessment of sleep apnea—among others. New developments in the understanding of the relationships between inflammation and atherosclerosis, routes of transcatheter aortic valve implantation, and use of cardiac rehabilitation are just some of the other topics covered. Even completely new approaches to existing problems, such as using remote magnetic navigation for atrial fibrillation ablation, are presented.

Imagine, if we have to start rationing healthcare, having to make decisions based not upon good clinical judgement but on established guidelines or insurance rules. We arguably have this to some extent currently, as some insurance companies refuse to cover certain procedures despite widespread coverage by others. One example is coronary computed tomography angiography: Aetna, United, and Medicare cover this test for symptomatic persons in all 50 states, while Blue Cross/Blue Shield largely does not. Such random and misguided ‘cost containment’ strategies will undoubtably lead to worsening healthcare delivery. They will effectively remove the clinician as the decision-maker about which test may be best in a certain situation, having to defer to some national policy decision made by people more worried about cost containment than patient care. In response to this, the current issue also highlights Hospital to Home (H2H), a national quality improvement initiative designed to help reducing unnecessary cardiovascular-related hospital readmissions. This can only help spread the healthcare dollar.

While the solutions may be difficult, we have to support policies and unfortunately become more politically active in this new environment. I would encourage all to stay involved in the progress—or lack thereof—in healthcare politics. Whether that means simply writing to your Congressperson or Senator, or making a contribution to a Political Action Committee, we need to get more involved as healthcare providers. Almost every medical society has some form of advocacy, and lending your voice can only make the message more resonant in Washington.