So yeah, it’s back in the news with the Senate scheduled to vote on the supposed
“doctor reimbursement Medicare fix.” Sounds like something Wile E. Coyote would order from ACME, doesn’t it?
Sen. Tom Coburn (R-OK)–a practicing physician, and all-around smart business guy–has a great plain-language explanation of what’s at stake, and what’s really going on.
In short, the Senate’s recent debate about physician reimbursement rates has been nothing more than a regularly-scheduled hostage crisis in which doctors facing payment cuts are held captive by politicians who want to achieve unrelated ideological goals. In this case, the ransom Senate leaders are demanding in exchange for a doctor fix are cuts in the successful Medicare Advantage program that gives seniors greater choice and access to health care.
The real debate, then, is not about reimbursement rates, but government-run health care vs. individually-controlled consumer driven health care. If that is the debate Senate leaders wish to have, they should have that debate directly – not stage a diversionary hostage-crisis that harms doctors and patients.
As a doctor, the hostility toward private plans among some of my legislative colleagues is confounding because private plans have a proven record of better benefits and quality, superior clinical expertise for coverage decisions, and increased access for vulnerable and minority populations. Medicare Advantage offers seniors personal choice and control over their health care decisions. More than one out of every five seniors rely on their Medicare Advantage plans to provide an alternative to government-run Medicare. Yet, the Democrats’ plan would inexplicably limit the availability of these options for seniors. This misguided position is not based on any empirical data, but pure ideology and hostility to individual freedom and choice in health care.
The irony of this debate is that the so-called “crisis” in sustainable Medicare reimbursement rates is caused by policies that lead to unsustainable increases in costs. Medicare was designed so physician reimbursement rates would keep pace with costs. Yet, this broken payment system predictably leaves doctors facing a larger cut every successive year – hence the annual crisis that requires difficult maintenance. Instead of fixing this problem once and for all, Senate leaders, and presumptive Democratic presidential nominee Barack Obama, want to not only enshrine this dysfunctional model in Medicare but apply it to the entire health care system.
In other words, instead of dealing with the real issue, instead of helping to explain it to their constituents, certain senators are obfuscating and turning the debate into yet another Punch-and-Judy show. No wonder, as the Anchoress pointed out in a related piece yesterday…”Socialized Medicine Looks Inevitable:”
Beyond a sense that health care in general is a good thing and people should have it, notoriously unwonky Americans seem not to have been paying strict attention to the issue. In October 2007, Americans told Gallup that health care reform was important, but hey, any old plan would do. Writing for the Cato Institute, Michael Tanner noted:
[The poll] showed more than half of Americans support every suggested health care reform, from the most market-oriented policies to total government control, even when those policies were mutually exclusive. More than half of voters said yes to a government-run single-payer system. But an even larger majority â€” more than 77 percent â€” favored â€œreducing government regulation of insurance.â€ [emphasis mine]
So, Americans are largely incoherent on health care. We would like a government-controlled program, unregulated by government, please. The stories from Canada and the UK sound troubling; the stories from France sound more reassuring. Weâ€™ll have what theyâ€™re having, but with extra choices on the side, because weâ€™re Americans!
Tell the truth: when you should have been pondering government and private-sector health care proposals in anticipation of this day, you were watching Dancing with the Stars. You can admit it â€” everyone else was, too â€” but it might be time to start paying attention, because incoherence coupled with recent feelings of economic insecurity may not translate into a levelheaded vote. Then again, it may not matter. In his column, Tanner gives bare outlines of the proposals being talked up by Senators McCain and Obama and writes:
Itâ€™s anybodyâ€™s guess how [McCainâ€™s and Obamaâ€™s policies will] develop. But as November approaches, voters will reach a fork in the road, and as Yogi Berra says, theyâ€™ll take it.
Some time after Labor Day, many Americans will start to focus on the November elections, and theyâ€™ll be surprised to learn that while they were at the mall, government-run health care moved from being a vague idea to an essentially â€œdone deal.â€ In just eighteen weeks Americans will, with every vote, submit to the idea of the government â€” that master of mismanagement â€” having a formidable control over their health care. Logic dictates that the common realities of age and illness â€” which come to us all â€” will steadily endow the government with ever-increasing authority over life choices and inevitable intrusions into decisions that should be private.
Uncharacteristically pessimistic for her, but she does make a strong point, one predicted by James Madison, writing as “Publius” in Federalist No. 61:
It will be of little avail to the people that the laws are made by men of their own choice if the laws be so voluminous that they cannot be read, or so incoherent that they cannot be understood; if they be repealed or revised before they are promulgated, or undergo such incessant changes that no man who knows what the law is today can guess what it will be tomorrow. Law is defined to be a rule of action; but how can that be a rule which is little known, and less fixed?”