A Side Deal on the Medicare Physician Fee Cuts? What Does That Say About the Chances for Health Care Reform?
John Reichard has dug deeper than anyone else into the Medicare physician payment problem in an important article in today's CQ HealthBeat.
He reports that the Blue Dog Dems (about 50 House moderate and conservative deficit hawks) may be willing to give the docs a pass by not requiring offsets for a two-year patch for their upcoming fee cuts--including the 21% fee cut due on January 1st. They are also reportedly willing to give the same pass for a three year alternative minimum tax (AMT) fix that would otherwise hit the middle-class hard.
A two-year "patch" for the Medicare physicians would cost $38 billion.
Reichard reports that the Blue Dogs' price is a statutory pay-go requirement--legislation that would require spending cuts or new revenue on any other legislation that would add to federal spending. He also reports that, "House Democratic leaders insist they'll back up the Blue Dogs on statutory pay-go and that if it isn't passed will demand offsets for the doctor fix..."
Which all begs a question: If these same Democratic leaders are so confident we will get health care reform this year, why are they doing a deal for a two-year doctor patch?
As I have been reporting here for months, health care reform is stuck in the mud over how to find the money to pay for it.
That Democratic leaders in the House are willing to find a two-year patch for the Medicare docs just reenforces the notion health care reform--and physician payment reform for that matter--is floundering for a lack of a clear course to do either.
4 comments:
The issue is a lot bigger than increases in Medicare physician rates--it's about the entire deficit. Speaker Pelosi has promised the fifty Blue Dog Dems that PAYGO legislation will be pursued in the House, and President Obama has pledged to push for its passage in the Senate.
If strict PAYGO legislation is passed, there can be no spending increases in entitlement programs--including Medicare, Medicaid, and VA health care--or tax cuts that would increase the deficit, unless offset by tax increases or other spending cuts. Virtually all current health care reform proposals would be subject to PAYGO.
The prior version of PAYGO was quickly watered down when rigid curbs on spending became politically inconvenient. However, whether PAYGO passes or not in 2009, the Blue Dog Dems are in a position to stop health care reform in the House if they believe it violates PAYGO intent.
Bob asks why Dem leaders are doing a deal for a 2-year doctor patch. The answer is easy. The Blue Dogs will at least be open to negotiation on reform financing, whereas the docs will scream bloody murder for the next several months if they think that reform is going to be paid for using their Medicare fees.
It seems that all these months Bob has been harping that the critical matter is cost, and fixing Medicare is central to accomplishing any other reform.
So, Bob, maybe in a future post, give us a little more "inside baseball" of how these machinations will work to lay the foundations for future policy. Or is this just a delaying tactic while more "support" and ideas are developed?
Thx!
President Obama's budget already assumes that there will be no 21 percent cut in Medicare's payments to physicians January 1.
And the administration has made it clear that healthcare reform will not be funded with deficit spending.
At the same time, there is a widespread consensus that Medicare needs to raise fees for primary care doctors, family practioners and some others who practice "cognitive medicine"--
talking to and listening to patients.
The Medicare Payment Advisory Commission has advised doing this in a "budget neutral way"--i.e. by slicing fees for some services provided by sub-specialists.
The sub-specialists will howl, (actually they have already begun to howl) but I'm quite certain this will happen. We know we overpay for some very lucrative services, and in some cases there is no evidence that patients benefit from these services.
Congress will not enjoy cutting some phsyicians fees, but no Congressmen wants to see Medicare begin to go broke on his watch.
So the fee schedule must be adjusted in a "budget neutral way."
It will be very interesting to see who becomes the new head of CMS . . .
Health care reform is a high priority and will need to remain in the forefront of all budgeting issues for President Obama; however, just as he mentioned several times on his campaign trail, this cannot be done by designating certain groups to be the ones who do this. Patient expectations truly drive the elective medical care market, and unreasonable expectations often drive up the cost of medical care, as well as the cost of medical liability. There should be some responsibility from the physicians, but there should be equal responsibility on the rest of us, as individuals. Who pays for the emergency surgery for someone who has neglected their heart disease, or who has put him or herself at risk for diabetes, or who has lung cancer from smoking cigarettes for their entire lives? We all do. And the heroics often employed to treat said individuals? We all know how expensive long term care for these cases can be.
We need to take responsibility for our own health so that in cases of medical necessity, there are funds to help us all.
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