Medicare, Congress and Confusion - Physician and Patient Risks
By Marion Edwyn Harrison (12/07/06)
Something must be seriously out of kilter when the following organizations spend substantial sums of money in lobbying-type advertising. This they have done the past two months in several publications seriously read, or believed to be seriously read, by Members of Congress and their huge staffs. These advertising entities include the American Medical Association, American Academy of Ophthalmology, American Academy of Otolaryngology, American Association of Neurological Surgeons, American Association of Orthopedic Surgeons, American College of Surgeons, American College of Surgeons Professional Association, American Society of Plastic Surgeons, Congress of Neurological Surgeons, American Hospital Association, Association of American Medical Colleges, National Association of Public Hospitals and Health Systems.
It would appear that every study, from whatever source or motivation, reveals that at best the overall net income of physicians has not been increasing commensurate with the very low rate of inflation, at worst that net income has declined. Medical care costs have risen but the causes are not a rise in physicians’ net income. Rather, they are malpractice insurance costs; and, in no particular order, hospital, clinic and office personnel, operating and other costs; medicine and drug costs; insurance-carrier slow-pay; insurance-carrier and Federal bureaucratic delays; so forth.
The medical profession is not noted for effective lobbying on its own behalf. This probably principally derives from the fact that most men and women who pursue the grueling and academically challenging route of four years of college majoring in a science (not “public policy” or any other type of “basket-weaving” major), then four years of medical school, then years of very low pay/very long hours residency, do so primarily to educate for a career of helping people and for the humanitarian and intellectual challenge; lastly, if at all, for the income. Hence, their national professional organizations in large measure reflect that resultant disinterest in self-protection.
In any event, absent definitive Congressional action the Bush Administration may implement proposals for Fiscal Year 2007 (October 1, 2006 - September 30, 2007) further to affect Medicare and more particularly to limit Medicaid reimbursements, more restrictively to redefine facility eligibility and certain “financing practices,” adversely to alter a tax rate and so forth.
Of course, the entire Medicare and Medicaid concepts are controversial. However, absent a sweeping and inclusive revamping of either or both, which nobody presently appears seriously to advocate, the findings of a 2006 American Medical Association survey are alarming (even assuming, as I do with most polls and surveys, that the percentages may not be too precise). It is reported that, if the projected Medicare and Medicaid cuts are implemented, 45% of physicians plan to decrease the number of new Medicare patients they treat; 50% plan to defer the purchase of information technology; 37% who treat patients in rural communities plan to discontinue rural outreach services; so on.
For purposes of this commentary the details are immaterial. What is material is the need for the closing 109th Congress, on balance having performed inadequately for its two-year life, in its final session to legislate - if nothing more than a temporary elongation of the present requirements.
Beyond that, the Department of Health and Human Services and Congress direly need to cooperate in a major, serious and objective study of the needs of Medicare and Medicaid, especially in terms of dangerously deficient physicians’ incomes and the risk of lessening care of those patients most needing care. Already some, apparently objective, sources are predicting a major shortage of physicians by 2020.
More imminently, continued confusion and lack of reality in the Feds’ handling of the medical profession increases the risk of a liberal assault against the whole system in favor of massive socialized medicine. Lest we forget, a certain Senator, considered a likely 2008 Presidential candidate, once advocated massive socialized medicine.
Marion Edwyn Harrison is President of, and Counsel to, the Free Congress Foundation.
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