I'm a little surprised this hasn't been addressed here:


Physicians press lawmakers to stop Medicare pay cuts
One senator warns that a proposed 18-month payment patch could be shortened if new spending requests bog down the legislation.

By David Glendinning, AMNews staff. April 21, 2008.

Washington -- Nearly 1,000 physicians convened in Washington, D.C., earlier this month to help lobby lawmakers on Medicare payment reform in the face of a tight time line and an even tighter budget.

Although the American Medical Association's National Advocacy Conference covered a range of health policy issues, its main focus was on patching the Medicare payment system that otherwise will cause a 10.6% reduction in doctor pay starting July 1. The event featured congressional speakers and an opportunity for more than 100 physician and medical student attendees to meet with lawmakers following an April 2 rally on Capitol Hill.

During the rally, white-coated physicians held up signs calling for action on the Medicare issue and chanted, "We care, be fair."

Shelley C. Glover, MD, a Florida gynecologist, said afterward that she planned to warn her congressional lawmakers about the difficult decisions physicians are being forced to contemplate under the threat of rate cuts. Her practice decided in 2006 to stop accepting new Medicare patients, and she fears that a double-digit cut would cause her to stop seeing Medicare patients altogether. "We have new patients calling up every single day looking for a gynecologist, and they can't find one in my town," Dr. Glover said. "It's horrible, but we just can't afford to do it."

Mary S. Carpenter, MD, a family physician in Winner, S.D., said that some areas of the country would be hit especially hard by rate cuts. South Dakota physicians, for instance, already receive some of the lowest Medicare rates in the country. Doctors there who are nearing retirement age face the "nearly impossible" task of recruiting new physicians to take their places, she said. Payment reductions would make the effort even more difficult.

AMA President-elect Nancy H. Nielsen, MD, PhD, said it was remarkable that so many physicians came to Washington to press the Medicare issue themselves.

"There are patients at home that are not having our services today," she said. "This is so important that surgeons, psychiatrists, internists ... we all came here to the halls of Congress to say, 'Remember the promise you made to our seniors; now it's your job to keep that promise.' "
The response from Capitol Hill

As they prepared to share their stories on Capitol Hill, physicians attending the conference received updates from several lawmakers on a possible legislative response. Sen. Jon Kyl (R, Ariz.), said that most of his colleagues were leaning toward passing an 18-month patch that would prevent the upcoming cut from taking place and that would provide for a modest rate increase in 2009.

Kyl warned, however, that such an action would likely set up an even larger cut in 2010. The Congressional Budget Office in March estimated that keeping Medicare rates steady for the rest of this year and providing a 1% boost in 2009 would cost $37.5 billion over five years. But Congress could reduce that price tag to $8.4 billion if it allowed for a 21% cut to physician pay in 2010.

"You begin to get the drift here?" he said. "If something is $30 billion cheaper than the alternative, Congress is more likely to search for the easier solution."

In addition, even such a short-term solution still could be torpedoed if lawmakers attempt to attach billions in new spending in other health care areas, Kyl said. He said the 18-month patch might turn into a six-month measure if Congress struggles to find the necessary financial offsets for more controversial spending proposals. This would require lawmakers to act again by the end of December on physician payment or else allow a cut to go through at the beginning of 2009.

"Is the physician update for the next 18 months ... worth it to not have additional new spending, as is being proposed by some in Congress?" he asked. "There's a trade-off here."

The AMA supports a bill authored by Sen. Debbie Stabenow (D, Mich.) that would prevent the 10.6% cut from occurring July 1 and give doctors a 1.8% raise in 2009 based on the projected increase in the cost of practicing medicine. CBO estimates that solution would cost nearly $40 billion over five years.

Senate Finance Committee leaders are working on a bill they may take directly to the Senate floor rather than mark up in committee first, according to congressional aides. This tactic could save time but might leave physicians in the dark about what Congress wants their payment rates to be until much closer to the July 1 deadline.

Regardless of how Congress acts within the next 90 days or so, the cycle of last-minute, temporary payment patches must end someday, said Sen. Tom Coburn, MD (R, Okla.), who also addressed the conference. He warned that physicians might not like the way that the cycle is broken.

"As good a job as the AMA does, you're going to eventually get a 10% cut," he said. "It's going to happen, and maybe that will finally motivate the medical community in this country to start getting back in charge."



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I pity the person who goes under a doctor's knife the day this pay cut is passed.

What do you expect from socialized medical coverage. The health budget just becomes one more expense to the government that often requires trimming. Unfortunately a fully socialized healthcare system does not rpovide the individual with any recourse to spend their own money wisely on private care.

Didn't you get that memo? You're too dumb to take care of yourself and make wise decisions about your health.

Maybe, but what I was trying to get at is how to does a society expect it's best and brightest to be doctors if kids entering college see sh*t like this. Doctor? That's a 10% pay cut. Tort lawyer? No pay cut and lots more potential clients as the population ages. Let's think that one through for a moment....

This is just the beginning, seriously.

If socialized medicine becomes a reality in this country, especially Hillary's version, the quality and efficiency of healthcare in this country is going to plummet.

What do you think of the quality and efficiency of healthcare in the US today?

Nooooooo!

Impossible!

I think it is fairly jacked up due to poor Medicare reimbursement, greedy Pharmaceutical companies, and a lack of control over private health insurance.

I think the QUALITY of care is still fairly high. It's just becoming more and more of a beurocracy every day, though, making it harder and harder for good physicians to give timely care.

Turn it all over to the government and you get a COMPLETE inefficient beurocracy and no real incentive for any young talent to become doctors in the first place.

We'll end up with year long waiting lists for common surgeries, lack of common drugs for common ailments, and black market dispensing of medical care.

All in the name of fairness.

Quality is tops, affordability not so much.

If you have the money, it's great.

True that. Let's trace it back to part of it's source, though.

Medicare is now reimbursing just enough to pay for any given procedure. Sometimes not even enough to break even. With an aging population, it is not unusual for a medical practice to see 70% or more of their daily patients with Medicare.

When you work 70% of your day with barely enough revenue to cover you expenses, where does the money come from? You have to inflate your prices so that PRIVATE insurance companies are covering the costs for everyone else. This gets passed on to the employers and the individuals paying for private health insurance. In summary, the government has passed off the cost of healthcare for the elderly on to us in the form of both taxes and increased insurance premiums.

So let's give the government MORE control of medicine, since they kick so much ass at it.

Healthcare fun fact: 47% of healthcare is subsidized by the government already.

Truth. I worked for a software company that does point-of-care software for hospitals, and one of our features we liked to sell was the automated medicare documentation. The hospitals HATE working with Medicare because they require so much paperwork (which costs money to do!), and Medicare constantly screws them on the reimbursement. Our software was sold with the promise that they'd be reimbursed more by medicare because it helps them make it through all of the red tape more successfully. And you're right, they're not going to do anything at cost, so of course they're going to make up for it by overcharging the private insurers.

So, if we socialize medicine, there won't be private insurers to make up for it any longer. Something will have to give, and that will either be discontinuation of treatments that Medicare has a history of skimping on, or simply lowering the quality of the care in order to make it cheaper.

I think it will most likely be both.

Let's take France's model healthcare system as an example. If you are just looking at the numbers, the population of France's health is close to as good as anywhere in the world.

You are already seeing common drugs being harder and harder to come by, though...simple things like asthma medicine and even aspirin. You are already seeing physician's selling medical procedures for cash "under the table" also. Why?:

In America the average salary of a physician is 5 times the average American salary. Under France's government run program, they make about twice the average French salary. To be fair, Medical School is free in France now, albeit extremely competitive so they won't have to worry about student loans.

Now what happens if a similar situation happens here? Physician's who have already accrued 100's of thousands of dollars in student loans and have a mortgage and family to support are all of a sudden getting paid less than half of what they were? What about college students considering pursuing medicine? For what? 4 years of college, 4 years of medical school, and 4 or more years of Residency and Fellowship. And then you are making about as much as the manager at TGI Friday's. Sign me up.

Medicare payments and paperwork notwithstanding, why on earth would you all think that a hodge-podge of competing private networks would be more efficient than a well-organized single-payer system? This topic has been extensively studied by the World Health Organization, the NIH, the National Academy of Science, the General Accountability Office and the Congressional Research Office. Not to mention various agencies in every industrialized country in the world. Single-payer systems are far more efficient and cost-effective when it comes to delivering standard medical services.

The term "socialized medicine" is such an archaic and meaningless term. Virtually the entire industrialized world has accepted that one of the duties that accompanies good governance is to care for the health of citizens. In the end the goal is cost-effective for the nation as a whole. The US spends more money per capita on healthcare than any other country in the world, yet has a lower life expectancy, higher rate of medical errors and higher mortality rate than most of our peer nations. The US Government has been puzzling over this phenomenon for at least two decades.

It sounds great on paper. It also works well in the short run. The term socialized medicine may sound archaic, but it is apt.

You remove healthcare from the free market and it becomes stagnant. All the medical innovations America has made can be attributed to the free market system.

The life expectancy and other health related issues of our population is not significantly statistically different than our peer nations. The cost per capita IS significantly higher, and i've explained a good part of the reason for it above.

You really believe a government run single payer healthcare system would be more efficient? Please list for me the efficient government programs that we have in the U.S. Public Schools, Post Office, etc... Why would this be any different?

Take a look at the Canadian healthcare system. It's fine if you have a cold. You need your gall bladder taken out? We'll see ya in 6 months or so. That is NOT efficient and it's not good patient care.

That's not even to mention the quality of physician's we're going to see under that type of system. I'm a pretty firm believer in "You get what you pay for". You wanna pay a doctor shitty wages? I don't.

I appreciate your passion, but do you really believe that what we have here in the US is a "free market system" for healthcare? If we did, on what basis would you choose your healthcare network? It's not like determining the quality of linens.

What makes you think that physicians in other industrialized countries are paid "shitty" wages? Have you been to an American emergency room for emergency surgery? Have you been to a Belgian, German, Swiss emergency room? The high per capita cost of American health care is not the result of Medicare or SCHIP.

The US Government has been concerned about this for a long time. There are many analyses in the medical literature, and a detailed report on the failings of the US healthcare system when compared to those of other industrialized nations prepared by the National Academy of Science for use by the US Government in improving healthcare services in the US.

In 2007, the Congressional Research Service prepared a report for Congress on healthcare in the US. They concluded that while we do effectively implement state of the art technology,

...research comparing the quality of care has not found the United States
to be superior overall. Nor does the U.S. population have substantially better access
to health care resources, even putting aside the issue of the uninsured. Although the
United States does not have long wait times for non-emergency surgeries, unlike
some OECD [Organization for Economic Cooperation and Development] countries,
Americans found it more difficult to make same-day doctor’s appointments when
sick and had the most difficulty getting care on nights and weekends. They were
also most likely to delay or forgo treatment because of cost.

http://assets.opencrs.com/rpts/RL34175_20070917.pdf

Keep in mind that advancements in medical research do not originate in the pharmaceutical industry. Medical research has nothing to do with a "free market." The US is a research powerhouse because of the cooperative system that exists between the National Institutes of Health and academic researchers funded by NIH. It is this system that is responsible for the fact that the United States has been a leader in medical research throughout the world, not "free market" innovations by Big Pharma.

If Medicare or Private Insurance is not the cause of high per capita costs for US healthcare...than what is?

Ah, GSS, you hit on the heart of the matter. There are hundreds of thousands of pages of research on what leads the high cost of health care in America. We have an unruly, inefficient and difficult to maneuver system. I've read many thousands of pages on this, and even I'm still astounded by the things that I read. There are many different systems of single-payer healthcare that exist in the world. Many are fully public, many are highly privatized and included supplemental private insurance for specific contingencies. All cost less than what we currently do. And many have longer-lived and healthier populations. The term socialized medicine is truly out-moded in the modern world.

Interestingly, in survey after survey, Americans consider their health "good," and their care "good" as compared to other countries in which the populace is longer-lived and in better health. If people can't even judge the status of their own health, how can they effectively choose healthcare providers?

But it is the result of those programs. There is no market for insurance on the lower end of the cost spectrum because no company can compete with "free from the government". Combine this with the ever lowering reimbursment from these programs, see my header post in this thread, the industry is using progressive pricing against private insurance to offset the losses from government run systems.



That's wrong. Most modern medical advances have come through partnerships between 'big pharma' and Colleges/Univeristies. Read about Craig Venter's experience at NIH to see the effect NIH has had on scientific advancements. Lets also not foget that NIH is federally funded, which means it's research is subject to the whims and political lobbyists and pollsters much more so than the work pharma giants is, whose motivation is money.



The real question is not whether or not a socalized system of healthcare should exist at some level, most people agree it should, it's a question of our government being able to effectively and fairly administer it, which I find highly unlikely. Faith-based surgery anyone?




Maybe they value things other than optimal health and longevity. As for that second sentence, I pity you for believing that. No one has the right to make life and death choices for others, even if that other might choose unwisely. To say something like "you are too stupid so i will decide for you" is just not cool.