Is the Doc Fix Fixable?

Not without serious Medicare reform.

As the Senate continues to debate yet another stopgap measure to maintain doctors’ pay under Medicare, John Graham of the Pacific Research Institute has written the definitive piece (posted both at John Goodman’s blog and at Critical Condition) on the subject. “Of all the huffery puffery in American health policy, what is the most ridiculous?” asks Graham. “I think a leading candidate is the never-ending lobbying by the American Medical Association and associated medical societies to implement a so-called “doc fix” for Medicare.”

Read the whole thing. (The latest Health Wonk Review also touches on this topic.) Goodman highlights the bizarre manner in which the government set prices for various physician services, and points out that physicians, and the AMA, are constantly gaming the system.

Ultimately, chronic physician underpayment by Medicare and Medicaid is about the government promising more to the voters than it can deliver. Instead of telling those constituents, “We can’t afford to cover all your care, so we need you to assume some of the cost,” they say “we’ll just underpay doctors and paper over the problem.” As Graham rightly points out, the only true permanent solution to the chronic underpayment of physicians is to move Medicare to a voucher system, in which the liability of the government is fixed at a dollar amount, and retirees can take out Medigap-style supplemental insurance if they choose.

I have never felt more ashamed of the medical profession than I did when, last week, I heard AMA President James Rohack announce his advertising blitz on behalf of the doc fix. Nowhere in Rohack’s remarks was there any concern for the enormous amount of spending involved in a long-term reform-free fix—$239 billion according to the CBO—nor any constructive suggestions as to how to pay for such a measure. Maybe Rohack feels that it’s not his job to talk about that. But physicians are supposed to be more than just another special interest with their snouts at the till; they are supposed to place the good of others above their own.

Rohack, by contrast, makes it clear that his first priority is the bank accounts of his constituents. And yet, even on this dubious benchmark, Rohack has been a colossal failure. Rohack was a big supporter of Obamacare, even though lawmakers broke their promise to address physician underpayment (due to the fact that it was damaging the bills’ CBO scores). Even worse, the Affordable Care Act massively expands Medicaid, the program that underpays doctors so badly that they lose money on every Medicaid patient they treat. Over a third of doctors don‘t accept Medicaid patients, a number that is certain to grow.

I hope more physicians raise their hands to say that Rohack doesn’t speak for them.