The Gauge for Viable Healthcare Reform

by Dave Schuler on October 19, 2009

Both The Washington Post

IN THE WORLD according to Senate Majority Leader Harry M. Reid (D-Nev.), setting Medicare payment levels for doctors has nothing to do with health reform. Really. “Correcting the Medicare doctors’ payment discrepancy is a budgetary problem — health insurance reform tackles a serious regulatory problem,” Reid’s office said in a statement. “That’s why we need to fix the Medicare doctors’ payments first, outside of health reform.”

Where to start with this? First off, $247 billion — the 10-year cost of the fix — is one whopper of a “discrepancy.” Dealing with that “discrepancy” amounts to more than one-quarter of the cost of health reform. President Obama has vowed that health reform will not add a single dime to the deficit — but he is seemingly unfazed about adding more than a quarter-trillion dollars to the deficit by changing the Medicare reimbursement formula without finding a way to pay for it.

and the Chicago Tribune

Take the bill unveiled a few weeks ago by Sen. Max Baucus. It extended coverage to millions of the uninsured. There was the appealing cost analysis: The $829 billion plan would reduce the federal deficit by $81 billion over 10 years, according to the Congressional Budget Office. That sounded like a refreshing change from budget-busting Democratic plans in the House.

Except Baucus’ plan included some budgetary sleight-of-hand: He counted on $247 billion in scheduled cuts in Medicare payments to doctors.

Problem: Congress has regularly bowed to doctors and rescinded scheduled cuts in their Medicare payments. There’s no reason to believe that Congress will grow a spine and make those cuts stick. So there’s no reason to believe the Baucus plan will actually pay for itself.

are editorializing on the Congress’s failure to reduce Medicare payments to physicians despite their waving the projected cuts under our noses as a sign of their bona fides in healthcare reform (and being obligated by law to do so).

Keep watching this issue. It’s a gauge of whether the road we’re on will lead to healthcare reform that includes cost control or will simply accelerate the current debacle. If those who believe that extending coverage to more people will force the Congress to behave prudently are correct, then this is as good a time as any for them to start. If, on the other hand, those like me who believe that extending coverage will just make our budgetary system collapse faster are right, they’ll do what they’ve been doing for the last ten years and kick the can down the road.

{ 2 comments… read them below or add one }

dprosental October 19, 2009 at 11:00 am

Sorry to disagree but higher payments to doctors will induce more of them to accept Medicare patients, who often find it hard to locate a physician who will agree to treat them.Those billions could be so much better spent if anyone in DC would stop and THINK.
Ex: scholarships for med students who major in family medicine, public health, etc. in return for which they practice for X number of years in free and/or low cost clinics (this method has been used successfully for years by the armed services)

Tully October 19, 2009 at 12:44 pm

They’re not mutually exclusive. Even with “cost control” the path could still well lead to an acceleration of the budgetary collapse, unless by “cost control” we mean drastic rationing.

dprosental: WHAT “higher payments to doctors?” Failing to institute scheduled cuts is not “higher payments.” No increase from current MCR baseline is in the works. Indeed, there are massive real cuts (the complete destruction of MCR Advantage plans) scheduled over and above the bogus SGR cuts.

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