Is Medicare Over?

In 1997, Congress was dreaming of balanced budgets and envisioning the ranks of doctors living on the fat of their Medicare checks from the government. So they passed a “stupid law” that effectively created a new set of formulas for capping Medicare payments in the future if at any time doctors as a group exceeded certain prescribed aggregate limits in the present. While medicine is a noble profession, between carryovers of massive student loans to malpractice premiums that would finance most folks’ mortgages, except for a few highly specialized practice areas (particularly those that cater to the rich… like plastic surgery), being a doctor doesn’t really pay that well anymore.

Well, surprise, surprise, the magic Medicare numbers were hit, hard in deficit years, and the formula dictated a 21% aggregate cut in the level of Medicare benefits. Congress has delayed (but not eliminated) the effect of this cut several times (the last in June of this year). But on December 1^st, the cut rises to 23% and is quickly followed by another automatic 6.5% on January 1^st, effectively dropping the reimbursement to doctors who treat the elderly by almost 30%. I don’t qualify for Medicare (yet!), but this threat has already deeply impacted me personally, and I am sure this is a story that has been and will be repeated all across the country; my “miracle-working” orthopedic surgeon (he’s fixed my knees and shoulder when others has solutions that would have limited my ability to move) announced his retirem ent from private practice. Dr. Harold Markowitz will be teaching at UCLA and performing his miracles only for the indigent.

Congress will likely step in and mandate another extension, but it is exceptionally clear that the system they passed in 1997 doesn’t work, and given the number of extensions that have been implemented since then, Congress actually knows it screwed up. Doctors are already responding in droves that they cannot afford to add any new Medicare patients under this structure, and many, like Dr. Markowitz, have simply given up their practices. The November 1^st Washington Post reports on one perspective that might just find its way into the law: “Cecil B. Wilson, an internist from Winter Park, Fla., who became [American Medical Association] president in June, is pressing for a 13-month patch that would preve nt the Medicare physician cuts. In April, the Congressional Budget Office said that blocking the cuts until January 2012 would cost about $15 billion. A long-term formula fix, through 2020, would cost about $276 billion, it said.

“The AMA argues that a 13-month reprieve from the reductions would give it time to work with Congress to overhaul the Medicare payment formula. In recent years, the payment formula has called for cuts, but each time lawmakers have stepped in to block them before they took effect or shortly afterward. The AMA could use a win on the issue. The organization was sharply criticized by some physicians for endorsing the new health-care law without getting the formula straightened out in return.”

The “solutions” that Congress has legislated in recent years, particularly on complex issues ranging from the Patriot Act to balanced budget laws (as noted above), reflects a growing trend in which under-schooled legislators (although we have 16 physicians – and more on the way – in Congress) make decisions in difficult arenas without either fully reading or understanding what they are voting on. Instead lemming-like-legislators will either vote along party lines without independent analysis (or let their aides make the decisions for them), respond to special interests with campaign contributions as a reward (which can now be “secret”) or follow their slogan-bearing constituents who don’t have the slightest clue on the nuances of any legislation. Knee-jerk placation of momentary populist movements (sheep-followers) has replaced leadership.

We live in a complex society where the devil is most certainly in the details, but in the days (months, years) following our election, with a power shift and the inane filibuster rule likely to be invoked (both Democrats and Republicans have misused this Senate rule), we are likely to see America’s complex and dire needs fall prey to formulaic and puerile partisan bickering that our nation can no longer afford. If we don’t find a better way, the assumption that the United States will continue for hundreds of additional years might just require a reality check.

I’m Peter Dekom, and I for one will go down kicking and screaming to reverse this destructive trend!