The ‘doctor fix’ highlights the hidden truth in the healthcare debate

It is the question that rests at the very heart of the health care debate yet has never dared to be discussed.

Is health care enough of a priority to force small cutbacks in other government programs in order to make money available for the nation’s health?

Last week, Senator Majority Leader Harry Reid announced he would be introducing a freestanding bill designed to freeze the current rate of Medicare payments to physicians for the next ten years. The estimated cost of Reid’s bill is $240 billion over the ten year period.

The GOP, and at least five, key Senate Democrats, are complaining that breaking out the $240 billion cost into a separate bill is little more than a trick to avoid exceeding the $900 billion ‘magic number’ that would keep reform deficit neutral. Opponents are equally quick to point out that this was little more than the pay-off required to acquire the support of the AMA, and other physician organizations, for health care reform.

The opponents are right. This is the price of AMA support and the issue of payment rates to physicians certainly is a part of the cost of health care. Were the $240 billion to be included as a part of the reform bill, the costs would go from the roughly $900 billion price tag of the Baucus bill to a price tag of $1.2 trillion.

But this does not mean that Reid is wrong in attempting to resolve a problem that threatens dire consequences to America’s senior citizens. It just means that we don’t know how to pay for it.

Should physicians experience the planned 21% cut in Medicare payments, scheduled to take effect on January 1, 2010, along with the deep cuts in the years that follow, there is little question that physicians will be turning away millions of Medicare patients to make room for the millions of newly insured Americans, with better paying private insurance, set to gain health coverage through reform.

What’s odd about this latest argument is that few, if any, in Congress support these potential cuts in physician payments, a feeling summed up by Senate Minority Leader Mitch McConnell-

I don’t know a single person who wants to see disbursements decreased, But we shouldn’t do it by racking up more debt on the government’s credit card.
Via Time Magazine

So, Democrats and Republicans agree that cutting back on the doctors will do real damage. Yet, nobody knows how to pay the bill that will keep physicians from dropping our senior citizens from their patient lists.

What we are witnessing are the consequences of Obama’s requirement that any health care reform bill be deficit neutral. We should expect more examples as it will likely turn out that the price of real reform is going to top $900 billion.

While deficit creation has been the ‘boogieman’ in the health care debate, the assumption from the very start has been that a deficit neutral plan had to be created without touching other big spenders of government money. It is an assumption that continues to be untested.

Does anyone believe that there is not $25 billion a year in wasted defense spending that could be moved to the health care effort? Are government subsidies paid to farmers to not grow certain crops, in the effort to falsely sustain food prices,  more important than taking care of the nation’s healthcare needs?

Raising these questions will most certainly bring more special interests into the equation – maybe more than can be managed in our current political climate. Still, without a full discussion of our national priorities, we simply cannot pretend that we are having a true national debate on health care.

As we near the final days of the healthcare discussion,  we are likely to find that any health care reform that is pigeonholed into a pre-set price tag is not going to provide much reform at all. This reality will result in a reform effort that, while producing a political victory for the White House, does not  really make the needed changes and improvements to the health care system.

If the Obama administration really wants to come up with something that has a chance of meeting its stated goals, rather than simply creating a political victory, why not begin taking a look at other government programs that can kick-into the cost of health care, without sustaining any real damage to the goals of these other programs?

When one considers the United States budget as a whole, we really aren’t talking about very much money.