Monday, November 22, 2010

Not fixing the Doc Fix

Remember the shenanigans concerning the so-called Doc Fix perpetrated by the Democrats in their efforts to pass ObamaCare? The Democrats needed to do something to fix the Medicare payments to physicians but they didn't want to add the fix to ObamaCare because that would add $250 billion to the cost of the bill and expose the fantasy that ObamaCare would actually save money. So they promised that they'd pass it in a separate bill in order ot win the AMA endorsement for ObamaCare. But then they never got around to passing it. Now they're passing a "fix" that will last only until the end of the year. So they'll dump the whole morass onto the laps of the new Congress.
But Democrats left a permanent fix out of the final ObamaCare bill in order to keep the official price tag below $1 trillion. Democrats planned to pass the $250 billion "doc fix" later in a separate bill, but somehow they never got around to it. Even liberals can't always conjure up a quarter-trillion dollars on demand, and some Democrats wanted the fix "paid for" with other spending cuts, real or invented.

The result has been a string of temporary last-minute reprieves. This will be the fourth this year, which is even worse than the annual "doc fix" fire drill that prevailed under both Democrats and Republicans until ObamaCare sopped up all the easy budget money. The Senate's latest one-month version costs $1 billion and is paid for by claiming to reduce certain outpatient therapy payments by about $100 million each year for the next decade. Anyone willing to bet on whether those cuts will ever happen? We'll take the "no" side of that wager.

In sum, Democrats deceived the AMA about the doc fix and are now deceiving voters about how they'll pay for even this four-week reprieve. And they're dumping the $250 billion bill on Republicans.
Add this unfixed problem to the budget that the Democrats still haven't passed on the list of tasks undone by Democratic Congress. It is well past time for a real fix instead of these month-to-month band-aids.
This doctor-payment charade has served both parties since it was created in 1997 as a palm-greaser for campaign contributions and to disguise the real costs of Medicare as part of the Bill Clinton-Newt Gingrich balanced budget deal. But these Democratic abuses are something else. Three of the four stopgaps this year have passed after the deadline set by the previous stopgap, so for a time Medicare simply stopped paying doctors, causing back-office disruptions nationwide. Imagine if a private insurer pulled these stunts.

A more stable payment system that reflects the real costs of delivering medical care while reining in federal health spending would mean dumping the Medicare price-control model that has led to the current mess. A good place to start are Wisconsin Republican Paul Ryan's Medicare reform ideas, which were endorsed last week by no less than the long-time Democratic budget hand Alice Rivlin. Maybe now that the AMA has been exposed as fools one more time, its new leaders will support genuine reform.
We've been playing games with Medicare payments to doctors for too long. Both parties are guilty. The supposedly comprehensive ObamaCare package ignored the problem. It's time for an adult approach rather than the political pass-the-buck game that is well past its due date.