Monday, November 15, 2010

The Coming Medicare Bomb - Again

In my paper this morning was an editorial by a local physician pointing again to the issues raised by how we currently pay doctors for seeing patients under Medicare.  Here is a similar editorial in the Nashville Tennessean by a physician there.  Both point out as well that these reimbursement issues apply to Tricare, and so apply to the families of active duty service members.

Of course, receiving 25% less money for the same level of care, the same number of patients and procedures, is a problem for most doctors, who are, as private practitioners, essentially small business owners or participants.  While most are all for looking for more efficiencies and other ways to save money, that won’t be enough.  So, some doctors are deciding that they will not accept any new Medicare patients.  Of course, as our society is aging and living longer, there are more and more new Medicare patients all the time.

These doctors aren’t pointing to new discoveries.  These difficulties have been known for a while.  Yes, there was a new story in the Boston Herald this weekend; but, there was also a paper ten years ago.  In fact, I found a story in the New York Times in 1992.  That’s how far back this issue goes.

For a number of years now Congress has been acting every year for some time now to stave off the reductions in reimbursement.  They’ve prevented the problem from getting worse, but they haven’t done what needs to be done to make the problem better.  That would require reconsidering the way in which these reimbursements are set.  Unfortunately, that’s a lot harder than simply saying, “Well, we just won’t allow that change  - this year.”

It seems to me that there is a failed premise behind this.  The idea is that if Government restricts what doctors get paid, the doctors will buckle down, become more efficient, become more productive, and costs won’t rise.  Of course, other costs aren’t controlled that way.  So, the doctors have been paying more each year for everything from their supplies to their utilities.  They’ve had to pay their employees more each year.  They’ve even had to pay more each year to provide their employees with health insurance.  At some point these lines have to cross: doctors can see only so many patients, and can provide only so many services, and sooner or later they simply can’t “do more with less.”  There simply isn’t anything more to cut.  Politicians love to talk about “trimming the fat,” but sooner or later there’s no fat left to cut – and eventually damned little steak!

The doctors whose editorials I cite want folks to communicate to members of Congress.  I think that’s a good idea, even if in the current climate one could feel hopeless of actually being heard.  I think it’s a good idea to send an email or a fax, or make a phone call – or even send letter by post, despite the fact that security will slow delivery.  No, it probably won’t be fixed quickly.  But if we as citizens push steadily, it can be fixed.

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