Health Reform and Issues of Substance

There is substance – the way things are – and there is smoke and mirrors – the way you want people to think they are or think they will be. To put it another way – there are substantial issues, and there are insubstantial illusions. Or, if you wish, there is political spin –hard realities on the ground versus rising hot air in the stratosphere. President Obama may be right. Things may get better, but for now, substantial conditions beat ethereal projections.

In a June 15, 2011, Real Clear Politics article “Blue Smoke and Mirrors,” Jay Cost frames the Substantial vs. Illusion issue this way.

1. The economy is substantially weaker for Obama than for other previous presidents who won reelection.

2. The deficit is now substantially higher than before.

3. His major domestic reform--Obamacare--is substantially more unpopular.

4. The American people are substantially more pessimistic.

Substantial Health Reform Issues

Among the substantial health reform issues are these.

ONE is how to head off the 29.4% cut in Medicare physician payments scheduled for January 1, 2012. Physicians are now reimbursed at roughly 78 percent of costs under Medicare, and just 70 percent under Medicaid. Result? More and more physicians are opting out of the government programs altogether. As many as a third of doctors do not participate in Medicaid, and 13 percent won't accept Medicare patients. A 2010 poll by IBD/TPP found that 45 percent of physicians would consider leaving their practice or taking early retirement as a result of Obamacare (“Obamacare Spurs Doctor Shortage, “ Newsmax, May 15, 2011). A 29.4% cut would surely exacerbate the doctor shortage, and it could not come as a worse time, with estimated 10.000 baby boomers entering Medicare every day.

TWO is a Congressional Advisory Group recommendation, about to be released that would require pre-approval for Medicare payments for imaging services such as CT and MRI scans and nuclear imaging. These costs grew from $6.5 billion tp $11.7 billion from 2000 to 2009 and are still climbing at 15% each year. These numbers are substantial and will not be easy to reduce since imaging tests are the diagnostic foundation for performing hip and knee replacements and cardiac stents, much sought after by Medicare patients. Obamacare proposes to cut $3 billion out of imaging in the next ten years. As a June 14 , 2011, Kaiser Health News report (Doctors Balk at Proposal to Cut Medicare Use of Imaging,” comments, “ Even before its official release, a a new proposal is sparking a furor among physicians and patient groups. The battle show hard it is to make even small changes in the sprawling program for the the elderly – much less overhaul it.”

To sum up,

With Medicare, it’s hard to change things substantial,

that relate to medical matters that are also financial,

that may involve not having enough physicians available,

to perform procedures doctors and patients consider unassailable.

Where you stand depends on where you stand on matters circumstantial.