The "Doc Fix" and Health Care Reform

I've been following the hullaballoo over the memo of questionable and unverifiable origin, circulated by Republican operatives, that purports to claim that some official Democratic Party representative has instructed Democrats to keep mum about the so-called "Doc Fix" that would bust the deficit-reducing CBO score of the Health Care Reform bill currently being considered.

Well, I'm convinced that the document is a hoax. And I think that the GOP should pay a heavy price for perpetuating such a hoax, or at least for not verifying the claims they made regarding this memo. The fact that the GOP shills who are responsible for disseminating this memo are unwilling to reveal even their sources for the information implies bad faith, if not outright and intentional lying, on their part. But I'm not really interested in piling onto the GOP. I expect them to play such dishonest, sleazeball politics. That's what they do. They don't idolize Karl Rove for nothing, you know. No, what I'm really interested in is what is at the crux of the matter: the Democrats' position on the so-called "doc fix."

What folks are saying about the fraudulent memo is that it may be "fake," but it's contents are nonetheless true. I'd like to challenge this interpretation on the facts.

Fact 1: The so-called "doc fix" (i.e. adjusting Medicare reimbursement rates paid to doctors by raising such rates to keep up with inflation in health-care costs, thus costing the government more money) is not currently law.

Fact 2: While Democrats have claimed that they will pursue a "Doc fix" down the road, there is nothing concrete about this claim other than that it is merely at this point a promise by politicians.

Fact 3: So, if the "doc fix" is not included in this bill, it cannot be scored in this bill in terms of its budgetary impact. To do so would be like saying that any future promises to build more VA hospitals or expand healthcare services to Veterans or subsidize med-school tuitions for veterans, etc., etc., must be scored in this current health reform bill. And this is patently ludicrous. Pretty soon, any bill seeking appropriations down the road, from military supplementals to highway reconstruction funds to agricultural subsidies could be claimed as something that would bust the budget-savings of the Health Care Reform bill were it to be included in the scoring process of the measure. Absolutely ludicrous.

Here's what I think is going on with the so-called "Doc fix" and what will eventually happen down the road when the time comes to debate and discuss such a fix:

1. The Democratic leadership is promising to take up and consider a "Doc fix" later in order to keep Doctors on board with the Health Care Reform measure.
2. The Democratic leadership, in separating out the "Doc fix" from the current Health Care Reform bill, are basically indicating that any future "doc fix" is not a "guarantee" of passage at all. In fact, Republican critics are speaking as if the "doc fix" is a guaranteed thing down the road. If they are so opposed to what it would do to the deficit, why wouldn't they just vote "No" as a block on this fix when it comes up down the road. Surely they could do this and thus the savings in both the current Health Care Reform bill would be maintained and any future deficit-funding liabilities would be avoided, too. But I suspect that the GOP knows that even many of its own members won't vote against the "doc fix" irrespective of its impact on the budget. In short, the GOP is just as likely to vote to deficit-finance the "doc fix" if considered on its own as they claim the Democrats would have to do if it were scored in the current Health Care Reform bill.
3. When the time comes for taking up the so-called "Doc fix," Democratic leadership will expressly look at how such a fix will impact the budget and will seek to mitigate its costs in other ways.
4. If those "other ways" to balance out the costs of the "doc fix" do not materialize because of a lack of Congressional will to make hard choices in doing so, then the "doc fix" will simply disappear into the ether (assuming the GOP sticks to its "fiscally-responsible convictions") and doctors will have to come to peace with accepting Medicare reimbursements at the lower rates.
5. This is just as likely a scenario to happen (in fact it's a more likely scenario, if you ask me), than Democrats passing a "doc fix" that's not paid for and is deficit-financed.

Democrats may take some heat for this from Doctors should this come to pass (but I'll bet some Republicans who also don't want to deficit-finance the "doc fix" will take some heat, too), but there is nothing inherently deceptive, nor budget-busting at all, in the Democrats choosing to separate out the issue of the "doc fix" from the current Health Care Reform bill. In fact, I think its a sound strategy for tackling the thorny issue of budget balancing in a way that allows Congress to gauge the sentiment of public opinion on the issue of Medicare compensation rates for doctors. My feeling is that the vast majority of the public will not have any problem asking doctors, if they want to suck at the government Medicare teat, to sacrifice their third Mercedes and their heated swimming pools to help balance the budget while helping more uninsured folks get the health insurance coverage they need. Doctors know that, too. And so do Congressional Republicans. I'd LOVE to see Congressional Republicans have to stick with their budget-balancing principles and vote "NO" on deficit-financing of such a "doc fix." But I know that Republicans, who wouldn't dare be principled fiscal conservatives on this issue alone, would love nothing more than to have the cover of the current Health Care Reform bill, which they can feel comfortable about voting "No" over because they've vilified it for so many other reasons, without having to deal with the fallout from dealing with a "No" vote on the "doc fix" by itself. And it is for these reasons why both groups, Doctors and Republicans, so desperately want this "doc fix" to be built into the current Health Care Reform bill. For Republicans, it's a way to sink the overall Health Care Reform bill, thus preserving the insustainable status quo, and shielding them from the heat they would face over a "No" vote on the "doc fix" by itself. And for Doctors, it's a way to make sure that there's more money available in the pot of federal resources to fund the "doc fix" and thus maintain the health of their swollen bank accounts without having to compete with those other claims on federal resources that come with giving the uninsured access to health insurance and affordable health care.

Fie on them both.

I HOPE that Health Care Reform passes AND that the "doc fix" ultimately fails.

As for my Doctor-friends who might be perturbed by my position, I say: come down to earth and live with rest of us. Out of all my doctor friends, there is not one whom I know who isn't living a very, very, very comfortable life -- even those who live primarily on Medicare reimbursements. It won't hurt you to live with a little less; and it shouldn't hurt you at all (in fact, I would imagine it would please you, being that you're supposedly a healthcare professional committed to saving lives) if living with a little less means giving your fellow human beings a chance to get affordable healthcare and to live longer, more productive lives.