Dan brings an argument that since the portrayal of podiatrists as being financially lucrative as a career, no congressman may avert the 21% Medicare cut scheduled technically for this Monday yet stayed by CMS/HHS for 10 days. I think most lay people and even government bureaucrats understand impending stresses on physicians. Although there are many in Washington which may express empathy, they do little to implement meaningful policies. Many times, government intervention as well-intended as it may have been, in essence, creates unintended consequences. Here are some examples. I love politics and the political involvement of Americans in their government. They may be called "radicals" and "tea-baggers," but I think so were our founding fathers! I have always thought that the average small business person or family person who budgets the family plan has more "common sense" than some of our elected officials.
1. One needs to go back to the Russ Feingold Amendment on deficit reduction in the early 90s which attempts to fix costs of various government programs and contain their expansion. This particularly affects us all today with the implementation of the 21% cut and the failure of the Congress to "fix" the SGR (Sustainable Growth Rate.) In the early 90s, a smaller percentage of the American population consisted of seniors as compared to their demographic make-up of the American seniors to total population today. The formulation of the program cost was NOT linked to senior population serviced under this plan. In fairness, all government plans/budgets did not take into account population serviced. As such, for illustration purposes (since these numbers are fabricated) if there were 10 enrollees in the Medicare program 20 years ago and currently there are 30 with the budget of the Medicare program set to no more than rate of inflation, there would be a "decrease" in expendable funds per enrollee. THIS IS THE MAIN PROBLEM!
From this, MOST of physicians' stresses arise. The reason is that this "budgeting" problem leeches into the private insurance sectors which "price" participation rates. Without reform on this issue, most other issues are simply applying "bandaids" to gaping wounds.
2. Implementation of new programs without proper financing (Medicare Part D.) Prior to the implementation of Medicare D, approximately 75% of seniors had drug coverage through the employers they had worked for. My impression is that Medicare Part D should have been a "catastrophic drug plan." What do I mean by this? Well, most retiree drug plans may have a cap. Let's say $15,000-50,000.00. Suppose Medicare Part D "kicks in" when the primary drug plan is "used up." The cost of the "catastrophic plan" is substantially less than an overall revamping of the entire drug delivery plan. Medicare Part D allowed for "no bids" for drug reimbursement....BIG MISTAKE!!! Worse yet, what in essence happened was a larger shift of most retirees' cost to be shifted from private to the public financing. Most businesses simply ceased providing drug coverage to their retirees (increasing their profit margins) and yet shifted costs to the taxpayer. The implementation of a Part D plan to cover all aspect of drug coverage instead of using it as a "catastrophic plan" reminds me of what I say to residents at times....."the enemy of good is perfection." The CBO (Congressional Budget Office) from what I remember stated the ten year cost of this plan would be $400 million dollars......were they off in a BIG way!
It is for this reason I view the combined Health-Senate Bill as a potential financial stress we may endure all (physicians and all Americans.) One only needs to look at what the results of the Medicare Part D plan created. My feeling is "fix what needs fixing" and "what ain't broke, don't mess with."
3. The ongoing problem of Congress and Pay-Go. Recently, this has been re- implemented . Hence, Rep. Bunning wants the 10 billion dollars found or raised to pay for the extension of unemployment benefits and extension of Medicare fees as it exists. I understand his position....even if it hurts me and I don't like it one bit. However, in light of the massive spending 1.6 trillion set and much NOT yet spent....I'm sure $10 billion should be an easy find. Correction!!!! I may be wrong....I am talking about Congress and Washington...LOL. Implementation to TRULY binding non-partisan committee for budgetary issues to make decisions our elected ones can't or won't should be done. And more importantly, there are those in Washington that say "Medicare is a great plan and its government healthcare." Yet, it is underfunded by $38 trillion dollars. I would venture to say that if a banking/financial institution was underfunded to such an extent, state and federal regulatory agencies would be taking it over and individuals would be going to "jail." In fact, no TARP plan would be extended here....well with the Federal Government....maybe.
4. My last point is controversial! Should we be retired at 65 y/o? When President Franklin Roosevelt provided for the implementation of Social Security Act with a retiree enrollment of 65 y/o, half the American population never made it to that age to become enrolled. We all know that there is overutilization of medical services, however, do patients contribute themselves to the over-utilization? What do I mean by this? I have always thought if "you have no skin in the game, you have nothing to lose?" Taking into account socio-economic factors and medical histories/conditions of patients....should patients bear more costs for "behavioral" aspects that affect their healthcare. I DO NOT want to see tobacco or alcohol or chocolate chip cookies outlawed. We are of a society with "free will" (although it is increasingly becoming more difficult to believe!) If you smoke, drink or eat to excess (free will, you know....) should you bear the cost for your "free will"?
