In recent weeks, Congress chose to play a dangerous game that could limit patients’ access to doctors under Medicare.  Democrats in Washington failed to move past short-sighted planning, partisan ideology and accounting gimmicks, while neglecting to protect Medicare beneficiaries’ long-term ability to see the doctor of their choice.

Congress must reverse the most recent double-digit Medicare cut permitted by the Senate Majority Leader, and we should do so without taking popular Medicare coverage options away from rural and low-income seniors. More importantly, Congress has a duty to move beyond a quick fix and change the formula that requires the annual cuts.

Medicare currently relies on an arbitrary formula, called the Sustainable Growth Rate (SGR), to set annual reimbursements for physicians who treat Medicare patients.  Most experts agree this effort to control Medicare spending for physician services is deeply flawed.  Unfortunately, some Congressional leaders prefer to preserve the formula as a tool to force physician groups to beg for mercy on a yearly basis.

The consequences of Washington’s Medicare accounting gimmicks extend far beyond the beltway; we’re talking about our parents and grandparents and whether they will be able to find a doctor or get the life-saving care they need.  The Office of the Actuary for Medicare warns the formula’s cuts could push patients out of Medicare, limit seniors’ access to physicians, and lead to higher costs in the form of “increased emergency room visits,” “increased mortality rates,” “and/or increased hospital utilization.”

Like many government-mandated price controls, the Medicare payment formula distorts the healthcare market and discourages physicians from participating in the program.  In 2006, the Government Accountability Office (GAO) reported seniors already have difficulty finding a physician to care for them, particularly “those in poor health.”  Another government report found one in four seniors who faced access problems in 2005 said “their problem finding a doctor was because they were covered by Medicare.”

In its effort to limit the total amount of Medicare spending for physician services, the SGR formula called for physician payments to be reduced for the past several years.  In order to avoid these cuts, Congress enacted temporary, short-term delays in these required cuts.  Because of the perverse nature of how the formula works, these efforts actually made the problem worse.

According to this year’s Medicare Trustees report, unless Congress changes the Medicare physician reimbursement formula, it will require a cumulative $220 billion cut in seniors’ physician services.  This scheduled cut only exacerbates the problems already caused by our looming shortage of nurses, primary care physicians, and heart surgeons.

The GAO aptly described Congress’ failure to face up to Medicare’s long-term problems as a “leadership deficit.”  Unfortunately, the latest proposals by Congressional Democrats continue to reflect the failed policies of the past.  If enacted, the most recent Democratic proposal to address the problem of physician payments would still require that Medicare payments to physicians be automatically cut by 20 percent in 2010.

Whether they like it or not, Congressional leaders must ultimately face the challenges facing the Medicare program.  In light of the $32.4 trillion long-term funding shortfall currently facing Medicare, solutions to these challenges only grow more painful for every year lawmakers continue to ignore Medicare’s problems.

Unless Congress agrees on a bipartisan long-term solution, seniors are going to face life-threatening cuts in reimbursement for Medicare physician services – just as the Baby Boom generation enrolls in Medicare.  It’s time to for leaders in both parties to demonstrate they can create bipartisan long-term solutions that put the interests of patients, caregivers and taxpayers ahead of political expediency.

This entry was posted on Wednesday, July 9th, 2008 at 1:25 pm and is filed under Politics, Healthcare .