Senate Leaders Holding Doctors Hostage
As a practicing physician currently serving in the United States Senate, I have been disappointed not only by Congress' inability to prevent cuts to the physician reimbursement rates within Medicare, but in our colleagues' inability to debate the real issues at hand honestly and constructively. While I appreciate the desire of Senate leaders to speak on behalf of doctors, I believe, as a doctor, that the American people deserve a better understanding of what is at stake in this debate, and in the larger debate about health care.
In short, the Senate's recent debate about physician reimbursement rates has been nothing more than a regularly-scheduled hostage crisis in which doctors facing payment cuts are held captive by politicians who want to achieve unrelated ideological goals. In this case, the ransom Senate leaders are demanding in exchange for a doctor fix are cuts in the successful Medicare Advantage program that gives seniors greater choice and access to health care.
The real debate, then, is not about reimbursement rates, but government-run health care vs. individually-controlled consumer driven health care. If that is the debate Senate leaders wish to have, they should have that debate directly - not stage a diversionary hostage-crisis that harms doctors and patients.
As a doctor, the hostility toward private plans among some of my legislative colleagues is confounding because private plans have a proven record of better benefits and quality, superior clinical expertise for coverage decisions, and increased access for vulnerable and minority populations. Medicare Advantage offers seniors personal choice and control over their health care decisions. More than one out of every five seniors rely on their Medicare Advantage plans to provide an alternative to government-run Medicare. Yet, the Democrats' plan would inexplicably limit the availability of these options for seniors. This misguided position is not based on any empirical data, but pure ideology and hostility to individual freedom and choice in health care.
The irony of this debate is that the so-called "crisis" in sustainable Medicare reimbursement rates is caused by policies that lead to unsustainable increases in costs. Medicare was designed so physician reimbursement rates would keep pace with costs. Yet, this broken payment system predictably leaves doctors facing a larger cut every successive year - hence the annual crisis that requires difficult maintenance. Instead of fixing this problem once and for all, Senate leaders, and presumptive Democratic presidential nominee Barack Obama, want to not only enshrine this dysfunctional model in Medicare but apply it to the entire health care system.
As a doctor, I know first-hand that the result of such a scheme would be not merely an annual crisis, but a permanent crisis in which even more of my medical colleagues would leave the profession rather than contend with ever-shrinking reimbursement rates and intractable bureaucrats in Washington. Senate leaders seem oblivious to the fact that this is an immediate - not far off - problem. Physicians across the country are increasingly refusing to treat Medicare (and Medicaid) patients because Washington's manipulation of the health care market is failing. Expanding Washington's lordship over health care would only reduce the number of doctors in the system as the number of seniors seeking to access Medicare swells.
Regardless of the outcome of the doc fix bill, this debate is a reminder of why physicians must get engaged in health care reform. Once we pass this 18-month patch, we will have to come back and figure out how to prevent a 21 percent cut in 2010. Doctors should make no mistake that the underlying problem is that bureaucrats and politicians in Washington are telling them how much they can charge to see their patients. If our health care system turns single-payer - as it eventually would under an Obama Administration - we won't be fighting cuts to care for our over 65 patients, but cuts over reimbursements for all of our patients.
After a compromise is passed and the phony theatrics end, Congress should immediately begin working on comprehensive reform. We can solve today's health care crisis by turning to a single-payer system - where care will be rationed and physicians will have to fight for perpetual reimbursement rate fixes for all of the patients they see - or we can solve that crisis with solutions that rely on American ingenuity and individual choice. My experience as a physician and legislator has taught me that the latter is the only long-term solution that will work.
In any event, our goal must be results for seniors and patients - not election-year posturing. Physicians want to care for their patients and receive a fair wage. Beneficiaries want the security of knowing medical care will always be available to them. We can achieve both if Senators are interested in a solution, not just an election-year issue.