Monday, November 23, 2009
Editorial: A real threat to Medicare
Pause health reform politics long enough to make a needed payment adjustment.
From the RoundTable blog
Read the latest entries
There is one real and immediate threat to Medicare patients that touches on the health care reform debate: Republicans and some fiscal hawks among Democrats are balking at a measure to avert a 21 percent cut in Medicare payments to doctors starting in January.
Such a drastic reduction in reimbursement rates could cause some doctors to quit taking Medicare patients, making it harder for seniors to see the doctor of their choice.
Last week, House Democrats voted overwhelmingly to prevent the cuts, not just next year but in the years ahead, by correcting what many in both parties consider a flawed payment formula. It was put in place years ago when Congress passed legislation intended to control rising Medicare costs.
Almost every year since, lawmakers have voted in bipartisan fashion to make temporary adjustments to the reimbursement rates. Last week, only one Republican -- Texas Rep. Michael Burgess, who is an obstetrician -- joined 242 Democrats to pass a bill that would make the "doc fix" once and for all. Eleven Democrats voted against it.
Efforts to pass similar legislation in the Senate failed last month when 12 Democrats and an independent joined with their GOP counterparts to block it.
Johnny-come-lately opponents said it was a political payoff to the American Medical Association for supporting President Obama's health care reform initiative. Yet their own votes in years past testify to the need for a fix to make reimbursements fairer and encourage continued doctor participation.
More serious critics were worried about the price tag: Fixing the flawed formula would increase the national deficit by an estimated $210 billion over 10 years, a legitimate concern.
To answer it, House Democratic leaders added a pay-as-you-go provision, along with an enforcement mechanism, that would tie future tax cuts or benefits increases to spending cuts or tax increases elsewhere in the budget, and make it part of the law. Republicans were unmoved.
The House originally had included the permanent payment adjustment in the health care overhaul it passed last month, but pulled the provision to keep the cost of the reform bill under Obama's price ceiling. The GOP is moving to block.
The "doc fix" has become entangled in political gamesmanship over the larger issue of health care reform, with physician reimbursement rates just another pawn on the board.
The Senate now must approve it or, in January, the game will be up.
