Is there a doctor strike in our future?
During the year long slugfest we like to call the healthcare ‘debate’, we’ve pretty much heard it all. Whether it was the secret deals with the pharmaceutical companies and insurance sellers or the government death panels that so desperately wanted to do in granny, it seems that every special interest in the land weighed in like the 600- pound gorilla they are.
Except for one – the doctors.
Sure, they’ve had a word here and there, but they’ve never been a major player in the process despite the fact that without them – there is no process.
Take away the doctors and there isn’t much reason to have a hospital, is there? Take away the doctor’s prescription pen and where does that leave the pharmaceutical companies?
Take away the doctors themselves and we are all in very big trouble.
Yet, as the health care ‘discussion’ devolved from ridiculous to worse, I can never once recall a politician saying, “I know…let’s ask the doctors!” Sure, there are a few ex-physicians in Congress who purport to speak for the physicians of America simply because they used to be one. But then, if these people were such dedicated physicians, why would they have given up so noble a profession for a life of comedy in the Congress
If you require proof of that statement, consider the fact that while Sen. Jim Bunning (M-Ky. – when it comes to Bunning, I believe he belongs to the ‘mashugana party’, thus the designation of “M’) led last month’s fight to block the bill that would extend unemployment benefits and continue to stave off a 21% Medicare pay cut to the nation’s physicians, this month it was Senator Tom Coburn (R-OK) – a physician – who led the effort.
Coburn was more successful than Bunning. As Congress enjoys their holiday break, the doctors who care for our elderly will be celebrating Easter knowing that when they return to their offices tomorrow, they will be paid 21% less for every Medicare patient they see.
While most docs are not yet saying no to Medicare patients as a result of the pay cut, many have re-prioritized their appointment schedules. That means that if a younger person with private health insurance wants an appointment, they will get it over the Medicare patient. With so many physician’s offices already pretty busy, Medicare patients may find themselves perpetually pushed to the bottom of the list, except for cases of emergency.
The 21% pay cut has been long coming – the result of a 1997 formula enacted to control Medicare reimbursement rates for physician care. The formula also affects Tricare, the health care program for the military.
Here’s how it works – the CMS, the government body that controls Medicare, adds up the total expenditures they make in payment to doctors each year. If the expenditures exceed a set rate, cuts are made to the Medicare reimbursement rates for the next year.
The problem is that the law lumps all doctors in together. So, if your doctor is careful about costs, avoids expensive and unnecessary tests, etc., it will do your doctor no good because she will still get the pay cut resulting from physicians who may have been less careful in their practices. Another problem is that the rates set by the CMS may be completely unrealistic.
For the past nine years, the annual expenditures have exceeded the set rate requiring a cut in physician payments the following year. However, each year Congress has voted to delay the cuts, allowing the total to run up to the 21% that has now gone into effect.
While Congress will, hopefully, restore the payments when they return from their break, this time there are some political issues that could get in the way. Permanently doing away with Medicare payment cuts means more budgetary costs to Medicare this year and in years to come. This is why the permanent fix was left out of the health care reform law. The Democrats did not want the costs picked up in the bill’s budget.
Of course, the Republicans know it. We can, therefore, expect that the coming Senate discussion required to reinstate the 21% payment will kick off cries of foul from the GOP.
Should the GOP have their way and continue to block the bill that would restore these payments to physicians, the Medicare system could go into meltdown as the doctors will have been pushed over what is a very thin edge.
How nuts could it get?
This week, a urologist in Central Florida posted a sign on his office door instructing anyone who voted for President Obama to seek care elsewhere.
While most would agree that turning away patients due to their politics does not fit the Normal Rockwell vision of the American physician we used to have, it certainly could be the sign of things to come.
In New Jersey, a group of physicians have filed their own lawsuit against the new health care legislation, claiming that they did so after learning that the majority of New Jersey physicians were strongly against the law.
This could all be adding up to trouble.
While the United States has never suffered a physicians’ strike, we may be testing the limits of how far the doctors can be pushed without beginning to push back.
In the past few months, cardiologists have suffered a 40% reduction in Medicare payment for certain services. Were the 21% payment cut to survive beyond the end of this month, many cardiology offices will cease to remain open.
Consider, for a moment, what happens to our senior citizens when their cardiologist office shuts down. If you think the emergency rooms are a problem now, you truly haven’t seen anything yet.
The physicians do, on one level, have themselves to blame as their lobbying efforts in Washington are abysmal. While the AMA remains the primary lobbying organization for doctors, the membership levels in the organization are at record lows and the clout once born by the AMA is now a shadow of what once was.
Specialties now have their own lobbying organizations, but they are small and appear ill equipped to play the game with the ‘big boys.’
Most physicians will tell you that they are doctors, not politicians- but that argument isn’t going to cut it any longer. If the doctors want to continue to do what they do, they need to get better organized and jump into the political game.
Meanwhile, the Congress may have one last chance to get things straightened out with the physicians.
Let’s hope they don’t blow it. If you thought death panels were a threat granny, wait until you see how granny fares when she can’t get in to see a doctor. You won’t like it. Trust me…I’m a …..no, I’m not. But I’ve sure spent a lot of time with them and I have every expectation I’m going to the doctors again.
I’d like of like them to be there when that moment comes.