Doctors Are (still) Greatest Threat to Seniors by Pat Conrad MD

It’s finally springtime, the sun is out, and I should know better than to read anything about budget battles or Medicare.  Dammit.

An article in the online Fiscal Times says “Congress Medicare ‘Fix’ Could Leave Seniors Paying More”, to which my initial response was, “Good!”  The setup is that the House of Rep’s is looking at a permanent reform for the annual farce we know as the “doc fix” when the Sustainable Growth Rate alchemy says its time to give the physicians’ Medicare rate a 21% cut.  Author David Dayen says that any fix sustaining physician Medicare reimbursement  – you may want to sit down, or pour a drink – would be “terrible news for restraining health care spending (most of which goes to labor costs), and for that matter inequality (my emphasis).  U.S. doctors of all types earn about $250,000 a year on average, twice the pay of doctors in Europe.  Economists…have endorsed increasing immigration of foreign doctors to bring pay in line with international trends and save consumers hundreds of billions of dollars.  But like most wealthy people, doctors have the ear of members of Congress, and therefore can successfully lobby to keep their Medicare payments as robust as possible.”

If you have not joined me in laughing and/or screaming obscenities at Mr. Dayen by now, then I really can’t help you.  The highlights:

– A Boehner-Pelosi deal to fix the idiotic SGR process would cost an additional $177 billion over the next decade, half of which will not be offset by other cuts and just be added to the big ol’ debt.  To get the Dems on board, the GOP might agree to another $30 billion extension of CHIP for the kids, a few million of which have been added to the rolls courtesy of the ACA.

– Half of the $70 billion in actual cuts would come from providers; the other half would come from Granny and Gramps via more means testing (taking more from those with higher incomes).

– All 9 million seniors with Medigap supplemental coverage would suffer higher out-of-pocket costs.  Dayen says that “The proper term for this is cost-shifting, pushing funding for a public program onto those who get the benefits.”  Whether or not the author got that irony, he added, “All of this is being done to protect doctor salaries…Maybe Medicare doctors shouldn’t endure a 20% pay cut, but the idea that they wouldn’t see patients if the cut were 5 or 7% doesn’t pencil out.”

And therein is the mother load (no, I didn’t misspell).  I believe that this article represents a large chunk if not majority of U.S. thought regarding Medicare.  Despite decades of evidence to the contrary, the popular presumptions are still:

• Medicare was and is, a good idea.
• Medicare is a right.
• Medicare is financially sustainable.
• All doctors are wealthy, therefore…
• …doctors can easily afford a haircut to help care for deserving seniors.
• Doctors will take that pay cut, and keep on working.

This is what voters, politicians, and egalitarians like the author are counting on, and when enough participating physicians retire, or quit taking Medicare, they will use the “need” for a further fix as the basis to force universal Medicare participation.