The Doctor Con …. WSJ   11.22.2010

Below is a recent op ed from the WSJ….

One of the tragi-comic sideshows of passing ObamaCare was the Democratic attempt to buy off the American Medical Association by promising a permanent fix to the Medicare payment formula for doctors. Apparently permanent is four weeks.

That's the upshot of last Thursday night's Senate vote to postpone an automatic 23% cut in Medicare physician payments, but only through New Year's Day. The House plans to approve the same deal next week, and you should think of this as Nancy Pelosi's housewarming gift for Speaker-presumptive John Boehner.

Democrats got their AMA endorsement of ObamaCare from immediate past president James Rohack, who was last seen leaving the Beltway on a turnip truck. 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.

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.

And this is my letter to the editor in response: …..

Thanks to the Wall Street Journal for elucidating the "doc fix" for what it is, a "con."  As a member of the House of Delegates of the AMA, I can assure you that there were many doctors within the organization who tried to convince our colleagues that their political tactics were more than naive.  Moreover, the SGR is a fixed payment system that denies the American public the opportunity to know the real costs of medical care. This type of fixed payment system also denies doctors our right to earn our own success and compete with one another to better serve our patients.  The AMA was wrong to want to fix the SGR and they were wrong to continually ask the government for more money in any other fixed payment system. Things are not reformed if Congress only adopts a different formula that continues to redistribute any amount of capped dollars within the doctor community.  Frankly, I want to work directly for my patients, not negotiate with anesthesiologists or orthopedists about who deserves what dollars.  

The good news is that the AMA has finally voted productively and helped write the patient empowerment act.  This legislation will allow patients to invest in their health and their lives by voluntarily contracting with their doctors for better care. That bill is ready for the Republican Congress to move forward in January.  This bill will bring the free market back into the healthcare delivery system, allow for Medicare to make a defined contribution towards non-emergent medical procedures or doctor visits, and will allow doctors to post their prices and bill the patient UP TO the difference.  As it is now, it is a felony for doctors to not charge the patient the 20% that Medicare does not pay. We would love to provide charity when appropriate but in order to do that we must be able to earn our success and compete with one another on behalf of our patients and their better care.   

The irony is that this simple change in the law would bring the marketplace back to the healthcare industry. Care would once again be affordable and accessible. Voluntary contracting saves the Medicare system and cuts governments spending in this mammoth, almost bankrupt entitlement program.  Finally, when doctors start to post their prices and patients become aware of the real cost of care, they will be better able to practice their right of self determination and exercise their right to invest in their health and in their life. 

As for your reference to the AMA past president and turnip trucks, a phrase that Johnny Carson popularized back in the 60's, allow me to suggest that the patient empowerment act is the AMA's introduction into a position of bold leadership.  Rather than sitting at the government's table and partake in a conversation we didn't author, we have grown the confidence to know that America's doctors must be the nation's leaders in health care.  We are taking back the profession.