Saturday, March 20, 2010

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.


Eric said...

Ask your doctor friends if they are advising their children to go into medicine, then get back to us on how all this is going to work out in the long term.

Huck said...

Well, Eric, they must be because applications for admissions to Medical Schools are still quite strong. Fortunately, I think it's still true that most young folks who want to be doctors are drawn to the professional because they actually care about healing people and saving lives as opposed to seeing it as a path to extraordinary wealth. And I'd wager that most of them still pretty much believe that even with healthcare reform, they'll still be able to live quite comfortably from the income they will earn as a doctor.

We've had Medicare for how long now? And what impact has this "socialist" program had on the recruitment and training of doctors?

Frankly, Eric, I'm a bit surprised at your comment, because parents advise their children generally to go into professions that will make them happy and fulfilled. Money rarely factors as the primary reason for such parental advice. If that were the case, many parents, given the relatively paltry salaries we earn, wouldn't ever advise our kids to go into education, or to become a professional ballet dancer, or to write poetry, or to become a Social Worker, or to take over the family farm or electrical contracting company. And yet not only do we continue to do so, but many kids still choose to take up such modestly paying professions on their own. Not everyone in this country needs that third Mercedes and a vacation home in the Florida Keys to be happy, comfortable, and content.

And I pity the doctor who would advise his kid not to follow in his or her footsteps because insuring the health of many millions of people would mean that they might earn only $1 million per year instead of $1.2 million.

Eric said...

Just wait, Huck, and see how those medical school applications go as you and yours continue to point guns at doctors and instruct them to "come live down here with the rest of us".

Medicare is a perfect example of what I'm speaking of: it is getting increasingly difficult to find general practitioners who will accept new Medicare patients (Medicare put one of our town's two doctors out of business, and the corporate "medical group" that moved in to replace her do not accept it, leaving our swollen population of senior citizens high and dry when it comes to seeing a local general practitioner... Unless they want to pay cash out of pocket).

Anonymous said...

Why should my husband, who works an 80 hour week sometimes much much more when on trama call, who is faced with the threat of being sued, at risk for disease from patients, makes life and death decisions on a daily basis on patients, come down to anyone's level. Did it take you 4 years of college, 4 years of residency, 5 years of specialty, to write this column?

Let's face it, those that are fortunate enough to get into medical school are harder working and smarter than the rest of the general population.

There is already a shortage of doctors in this country. How are we going to possibly provide the same high quality of care for an additional 23 million people, many of whom will still rush to the ER at the slightest thing? We cannot possibly sustain the number of doctors to accommodate the growing number of patients and offer the same care. We can't, plain and simple.

In the 30 years I have been married, my husband has missed weddings, graduations, school plays, birthdays, vacations lasting no more than a few days, and many more important occasions, all for the care of patients. Medicine is not a JOB it is a way of life! In fact my husband was not present at any of the births of our children as he was either on call or in surgery!

I have seen my husband come home dog tired from doing a surgery for 6 hours on a patient who was drunk and crashed his motorcycle, only to turn around later and sue him. I have seen him get up in the middle of the night, after a long day, go into surgery to treat an injured child, while he was sick himself.Or the patient who did not take care of themselves after surgery only to sustain a deadly infection, that again had to be operated on, and never once complained because it was his duty and desire to help others. How many people do you know that complain about their jobs who have much less stress than he?

If you are so confident that being a doctor is a job that anyone could do, or a job that should pay as much as a carpenter, then go do it! Spend hundreds of thousands of dollars in some cases, go into debt, earn your first pay check at 33, have no life for the 13 years of training, and ultimately giving to others more time than to your own family, enroll tomorrow!

And the last I knew this was still America the great, where people who worked hard were rewarded for their efforts. This is not a socialist republic where,

Equality of outcome refers to a state where everyone receives equal amounts of rewards and an equal level of power in decision-making, with the belief that all roles in society are necessary and therefore none should be rewarded more than others. This view is shared by some communal utopian socialists and anarcho-communists.

I will continue to encourage my husband to discontinue seeing medicare patients until the "Doc Fix" is put in place.


Huck said...

Bluesky - I don't question the commitment of your physician husband. All the doctors I know are good and noble people. But the choice of the profession is just that: a choice. It has its costs as well as its rewards. Just like any profession. I will say, though, that being a doctor is no more noble than any other profession. To claim otherwise is simply elitist and arrogant. Do you think other people don't slave over their professions, which they also may consider a labor of love? Do you think that only doctors come home dog tired from work? Do you think that only doctors work 80 hours a week and miss birtday parties and wedding anniversaries? Do you think that only doctors put in years of schooling only to collect their first paycheck at the age of 33? Do you think only doctors sacrifice for others in their profession? I have known too many people who are just as noble and dedicated and committed as your husband to their profession, and do their work without complaint just for the love of it, to think that doctors are somehow extra special people in this regard. Believe me that the quality of my life is just as well served by my plumber as it is by my doctor. And I also know that my plumber doesn't get a dime from the government for the work that he does and has to rely on what his customers can afford to pay him as compensation for his services.

The fact is that if I wanted to be a physician, I could. But I don't. Why? It's simple. Because I chose not to. Because I have looked at how I want to deploy my talents and abilities, and have weighed the costs and benefits of all the career options out there, and I have chosen something else. I don't regret my choice at all. I am quite happy and content with my life. I love my job and have no complaints.

You have every right to persuade your husband not to take Medicare patients. And he has the freedom not to. Again, it's a choice. With its attendant costs and rewards. There's nothing "socialist" about this. No one is "taking" anything from you. All that is happening is that taxpayers like me are saying we can't afford your services anymore at the price you want to charge, and so you'll either have to take what we can afford or we'll just have to part ways. Do what you think is best for you, your husband, and your family. I don't begrudge you any choice you make. And I hope you make tons of money at it and that your life is improved for it. But I, too, being a taxpayer into the Medicare system, have a say in how the government spends Medicare dollars.

Huck said...

Eric - Who's pointing guns at doctors and forcing them to come live down here with the rest of us? It's an exhortation, not a coerced demand. The fact is that the rest of us do not have the benefit of cashing in at the government trough. And living with the rest of us means not throwing a hissy fit when the customer (i.e. the US taxpayer) takes a look at their prices and says "No, thanks, I can't afford that price, but I can pay you this price." Eric, I have to ask: do you think we should pass the "doc fix" if it means deficit-financing it? Is it too much to ask doctors to either accept what we can afford to pay or opt out of the Medicare program altogether?

Anonymous said...

No comments!

Anonymous said...

I encorage all the other readers to ignore this either ignorant or arrogant blogger... don't waste your time on Huck who like sto comment on stuff he has no idea about...

Anonymous said...

Please ignore this ignorant and arrogant person "Huck". He does not have even a distant idea about medical profession...

Huck said...

Yeah, everyone, ignore this "Huck" on the basis of a complaint that is devoid of any substantive comment on the issue and that is posted by an "anonymous" person. I'd suggest that until Anonymous offers even a scintilla of an explanation for why this "Huck" has it all wrong, then it is Anonymous who is the ignorant, arrogant, and petulant one worthy of being ignored.