OP-ED

Nope. Won’t Happen.

Friday, June 18, the Senate aproved a plan that blocks a 21 percent cut in Medicare payments to physicians; the axe was scheduled to fall that day. Leadership on both sides of the aisle pushed for the reprieve; it will remain in place for six months. The measure will now need to be considered by the House, which in May approved a fix that would last longer. If the House agrees–and it is all but certain that it will–the 21 percent cut wil be replaced with a 2.2 percent pay hike. The bill will not add to the deficit. The proposal is fully offset by changes in Medicare billing regulations, antifraud provisions and the tightening of some pension rules, eliminating Republican objections that it would push the federal government deeper into debt.

In six months, Congress will have to consider the matter once again, just as it has ever year since 2003. This is the third time this year that Congress has averted Draconian cuts to physician’s payments. What, you might wonder, is going on? Here is the backstory: in 1997, Congress enacted a so-called “sustainable growth rate” (SGR) mechanism to keep Medicare physician reimbursement rates in check. Congress has never allowed the full cuts called for under the SGR formula to take effect and it never will.

Why don’t legislators simply repeal the cuts to doctors’ fees that they have been postponing for years? Why just put off the measure for another six months?

Because too few of our elected representative possess the chutzpah to stand up and say that blind across-the-board cuts were an extraordinarily dumb idea in the first place.

Nevertheless, most legislators understand that this crude solution will never be implemented. They know that while Medicare overpays for some servcies, it underpays many doctors.

The “Affordable Care ACT” that President Obama signed in March recognizes this fact; this is why it provides a 10 percent bonus for primary care doctors (pediatrics, internal medicine, family practice, geriatrics) as well as general surgeons who practice in areas where medical professionals are in short supply. At the same time, Medicare is reducing reimbursements to doctors who have purchased or leased testing eqipment worth more than $1 million for their offices. Reserach shows that in such cases, doctors order twice as many tests, exposing their patients to unnecessary risks.

Nevertheless, physicians who oppose they like to call “Obamacare” will use Friday’s postponement to scare seniors by pretending that a sword still dangles over their heads. “I may have to stop seeing you,” some physicians will say. “This reform legislation is going to lead to a Medicare meltdown.” Saturday, the day after the Senate approved the reprieve, the Washington Post ran an op-ed by Dr. Michael Newman, a clinical professor of Medicine at George Washington University , who wrote as if the postponement were merely a ruse, and that at some in the future Congress plans on enacting a “21 percent reduction [that] will make it prohibitive for many physicians — internists, geriatricians and family practitioners in particular — to continue caring for their Medicare patients. Congress’s annual moves to postpone further cuts in reimbursement amount to budgetary cosmetics that convince no one of the system’s soundness.” http://www.washingtonpost.com/wp-dyn/content/article/2010/06/18/AR2010061804700.html Newman did not mention the scheduled 10 percent bonus for internists, geriatricians and family practitioners, nor did he mention the 2.2% pay increase that replaces the 21 percent cut.

It’s worth emphasizing that health care reform has nothing to do with the SGR formula that calls for whacking Medicare reimbursements.

This ill-conceived law passed in 1997, long before today’s reformers came on the scene. Congress did not attempt to repeal the SGR as part of the Affordable Care Act because conservatives would have argued that this made reform too expensive. But everyone understood that legislators would address the SGR in separate legislation, and now it seems that they are figuring out how to cover the cost of a repeal without adding to the deficit.

In the end, many physicians will benefit from the reform legislation. Granted, some specialists well see reimbursements trimmed for selected very lucrative services. But under reform, all physicians will be eligible for bonuses if they deliver safer more efficient care that leads to better outcomes for patients. And financial incentives that encourage better collaboration among physicians should improve working conditions for many.

Maggie Mahar is an award winning journalist and author. A frequent contributor to THCB, her work has appeared in the New York Times, Barron’s and Institutional Investor. She is the author of  “Money-Driven Medicine: The Real Reason Why Healthcare Costs So Much,” an examination of the economic forces driving the health care system. A fellow at the Century Foundation, Maggie is also the author the increasingly influential HealthBeat blog, one of our favorite health care reads, where this piece first appeared.

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The Game
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The Game

The Players and whats up for grabs. Profits United Health Group 2010 $4.293 billion Here are some other 2010 budget numbers: Wonder what it cost CMS ( Can’t Manage Shit) to operate each year. $453 billion Medicare/// $290 billion Medicaid ///$78.7 billion Department of Health and Human Services/// UnitedHealth Group Awarded TRICARE Managed Care Support Contract … Jul 13, 2009 … UnitedHealth Group Awarded TRICARE Managed Care Support Contract for more than $20.3 billion. BILLIONS awarded and still to be awarded United’s AmeriChoice unit is the largest government contractor administering state Medicaid programs for the poor and federally sponsored plans… Read more »

Medicare Backlash
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Medicare Backlash

Limo Divers Protest Medicare Mediciad Reform Cuts, It’s rumored this issue could become part of the Tea Party movement. AmeriChoice Health also rumored to take a position on this issue. Recirculate those tax dollars? Help keep limo drivers working, benefits flowing and overpaid tax dollars remain in abuse. Medicare.gov as well as other Federal agency’s encourage you to report any fraudulent activities, yet, the same government agency’s were notified the way this company does business yet did nothing. Three years ago they were reported to these Federal agency’s and as of todays date not only were they allowed to continue… Read more »

Francis A. Toto
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The entire $2.3 trillion healthcare establishment will suddenly,violently collapse because of the same exact phenomena that cause other industries to suddenly collapse. The historical and scientific evidence is compelling. This industry has reached the catastrophic 4% threshold; sinking below this threshold, historically, has caused massive failure in the industry (1990-1999). For the first time, the real story is now being released to the American people. Extensively proven is the fact that this industry is hyper-sensitive to any small changes that cause the rate of growth to stall and decline.The American people, and the most vulnerable patients-the children, the elderly, and… Read more »

Nate
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Nate

Here in Ohio we pump our own water. Don’t need any government help for that. food subsidies actually increase the price of food in most cases not decreases it. In NV and many states they set the minimum price for milk. If they didn’t set a floor we would be able to buy it considerably cheaper. Sugar and many other products have import tarrifs to keep competition out and prices artifiaclly high. Thanks again Peter for wasting time with your inaccurate Dogma. Maybe you should try looking some of this up before you make it up?

ciphertext
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ciphertext

By the way, walking for cancer research is not sacrifice, maybe an inconvenience. Most of the fresh water is controlled and provided by government and we enjoy some of the cheapest food prices in the world because of government subsidies as well as the ability to grow our own. I’d hate to think what water would cost if private enterprise controlled it.Those government agencies that operate water purification and provisioning services are local. Those services are paid for separately from taxes. You pay a monthly usage fee to your water provider (municipality or other). They are not state or federal… Read more »

ciphertext
Guest
ciphertext

Peter –> “Any more than the cost of oil reflects “true” costs? Pollution, global warming, gulf oil disaster, wars in the Middle-east. We all pay cash for oil, yet where is the true cost reflected in the price? Does anything in this economy reflect the true cost? Ask a over compensated specialist if their charges reflect the true cost – I think they’ll say they’re under compensated” Pollution and global warming aren’t a “cost” in economic terms, rather they are a potential by-product of a manufacturing process. Indeed, human existence (which itself can be viewed as a production and manufacturing… Read more »

Peter
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Peter

“WOW your so right Peter, 100 TV evangalist are proof that 20 million christians aren’t charitable.” I didn’t say they weren’t charitable (did I), I said where’s the sacrifice? But it seems to be a money making enterprise that “20 million christians” blindly support. By the way, walking for cancer research is not sacrifice, maybe an inconvenience. Most of the fresh water is controlled and provided by government and we enjoy some of the cheapest food prices in the world because of government subsidies as well as the ability to grow our own. I’d hate to think what water would… Read more »

Nate
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Nate

WOW your so right Peter, 100 TV evangalist are proof that 20 million christians aren’t charitable. Your so smart, I think we should all stop posting and just wait for your postings of wisdow to come down and guide us. You have shown yourself to not be very good at math, can you calcualte what percentage of christains the TV Fleecers are then calculate how many Dems have gone to jail the last 5 years as a percentage of Dem office holders? hint your not going to like the answer. “You see, most people don’t require the other products, or… Read more »

Peter
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Peter

“The point of my discussion is that it currently isn’t possible to determine the “true” costs associated with providing healthcare services and related products, because the market prices do not reflect the true costs.” Any more than the cost of oil reflects “true” costs? Pollution, global warming, gulf oil disaster, wars in the Middle-east. We all pay cash for oil, yet where is the true cost reflected in the price? Does anything in this economy reflect the true cost? Ask a over compensated specialist if their charges reflect the true cost – I think they’ll say they’re under compensated. “Are… Read more »

ciphertext
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ciphertext

Peter -> The point of my discussion is that it currently isn’t possible to determine the “true” costs associated with providing healthcare services and related products, because the market prices do not reflect the true costs. If the one goal of this legislation is to make “healthcare affordable to the public”, then costs are but one component of healthcare. I’m focusing on costs, as that is a major, determining factor in market based economies. I would think it a good idea to have a consumer pay for their healthcare directly. I can think of no better way to expose the… Read more »

Margalit Gur-Arie
Guest

One more thing, Tom.
“By 1950 or so “we” had pretty much decided that families s/would not be left to fend for themselves, at least their employers would help out.”
Let’s set things straight. Employers are not magnanimously “helping out”.
Every dollar spent on health care in this country comes out of the wallets of working folks. Be it cash, reduction of wages, premiums, deductibles, co-pays and other out-of-pocket schemes, plain taxes and higher consumer prices. Every single dime is passed on before it’s even spent.

Margalit Gur-Arie
Guest

Oh boy…. Christianity and charity…. Yes, Tom, very Jeffersonian indeed. This is not about big versus small government and I seriously doubt that Mr. Jefferson, if he was alive today, would support the conservative agenda. On the other hand I can see Mr. Hamilton and his banking folks align right very nicely. So here is something about charity, Christian and otherwise; it does not work. Well, it does not work for those on the receiving end. It destroys today’s recipients and future generations too. Charity is humiliating, demeaning and aimed at gratifying those who give to charity and maybe even… Read more »

Peter
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Peter

“The best way to insure the optimal operation of any business (meaning reduction in costs through gained efficiencies) is to insure that the business is able to receive feedback from the market. Currently, that is not the case. The consumer of the service and product is often not able to provide that feedback.” So your solution would be for everyone to pay cash? That certainly would provide feedback, but not necessarily proper healthcare to everyone who needed it. You see, most people don’t require the other products, or can choose a less expensive alternative. As has been discussed here before,… Read more »

ciphertext
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ciphertext

I wonder why it is the seemingly automatic response for the modern day citizen to accept, as a solution, government (directly or via its agencies) regulation over some activity/process/operation/event that has been proclaimed “broken” by either some, few, or many. I can understand the desire for political “types” to desire such regulation as it would place control over non-trivial issues squarely in the lap of the governing bodies. While there are certainly many “issues” with health care in the U.S., it would seem the one that is getting the most attention is “cost”.My understanding of the legislation for Medicare and… Read more »

Peter
Guest
Peter

“Christianity and its charity are all about personal sacrafice, this is the anti-liberal perspective where charity is giving away other peoples’ money via government wealth redistribution. The right and christians do a far better job and do it far more efficently taking care of the community then the left and their government programs.”
Yes, it’s all about “sacrifice”??? The biggest liars (and hipocrites) are the “christian right”.
http://www.inplainsite.org/html/tele-evangelist_lifestyles.html