Sunday, June 29, 2008

Medicare Pay Cuts Imminent

Doctors Outraged;
Seniors See Prejudice against Aged;
Democrats Sense Potent Campaign Issue


“Time after time, Congress has jumped in at the last minute to block Medicare payment cuts to doctors. Will this be the time when time runs out?”

Jacob Goldstein,” Bill Blocking Medicare Pay Cuts to Docs Stalls in Senate,” Wall Street Journal Health Blog, June 27, 2008

“President Bush had threatened to veto the bill, in part because it would reduce federal payments to private Medicare Advantage plans, offered by insurers like Humana, UnitedHealth and Blue Cross and Blue Shield companies.”

Robert Pear, “Doctors Face Payment Cuts for Patients on Medicare, “New York Times, June 27, 2008

July 29, 2008 - On June 26, Tuesday, a handful of Republican Senators handed Democrats a campaign issue by voting against calling up a bill that would have blocked a 10.6 % cut in Medicare pay for doctors, thus killing it. Senate supporters fell two votes short of the 60 needed to close debate. The vote was 58 to 40. Senator Obama voted to block the bill. Senator McCain, who was campaigning, and Senator Kennedy, who is ill, did not vote
The House had voted overwhelmingly 355 to 59 to pass the bill the previous day.

Cuts are scheduled to start on Tuesday, July 1, while Congress is taking a July 4 recess, making a last minute reprieve unlikely.

On Campaign Trail

On the campaign trail, Democrats will argue Republican Senators’ vote favors big business, i.e. the private for- profit Medicare Advantage HMO industry and the unpopular President Bush. This tactic will anger 44 million Medicare recipients, a potent voting bloc, and 500,000 or so practicing physicians..

Physicians, and anyone else with eyes to see and minds to think, knows Medicare is the Sheriff of the health system and sets rules and precedents on health plan payments. Health plans obey those with the Medicare badge. Health plans follow Medicare in lockstep, especially when it benefits their bottom lines.

Consequences, Expected and Unintended

What are expected and unintended consequences of the Senate action?

On the “expected” side, you can expect

1) “Compassionate” Democrats will seize a wedge campaign issue against “Heartless” Republicans, who, they will say, care only for profit-making enterprises.

2) The senior vote. led by AARP and the like, will swing to Democrats,

On the “unintended” side, you can expect

1) Outrage among doctors and seniors: already Sermo.com has 1174 messages among doctors, some threatening to boycott Medicare and others saying they shut down practices to new Medicare patients.

2) Widespread protests among seniors, already upset about higher Medicine copays, increased premiums, and complaints of doctors about unfair Medicare restrictions and expenses.

3) Less access to primary care physicians, and specialists who conduct Medicare based practices.

4) Loss of morale among doctors, who will retire earlier, restrict access, cut Medicare services, and seek careers outside of private practice.

5) Cries of dismay among those unable to find a doctor and among doctors unable to afford to care for them.

6) These messages will become common, “Where have all the doctors gone?” “Will the last doctor in America please turn off the lights?” and among doctors, “We no longer accept new Medicare patients.”


In Short


This Medicare crisis will engage all politicians, Republicans, Democrats, and independents. This crisis will be about what you can expect, who will be the most politically correct. Expect an unprecedented wide protest among clinicians, who depend on Medicare to meet economic conditions. Expect outright outrage among Medicare patients, who depend on predictable physician relations. Expect campaign talk on what’s good for business ganders isn’t necessarily good for the physician and patient bystanders. Expect frequent reportage on the physician shortage. Expect Obama moral stigmas on McCain health plan market-driven enigmas. Expect a campaign battle for the minds the public who want choice and freedom and who aren’t mindless cattle. Expect patients to take sides on health plans versus doctors with whom their care resides

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