Medicare Cuts, Increase Pain but Fail to Cure the Disease

Our inept congress passed a health care reform law that included a 21% cut in Medicare doctor’s fees. All the talk now is about doctors leaving the medicare system. Others will simply seek new ways to game the system. One has to ask what were they thinking. Can continually cutting the fees paid to doctors support quality medical care?

It has been reported that there are hundreds of demonstration and pilot programs but they are stymied by a lack of provider participation due to lower payments. Maybe the answer is not found in lowering payments to providers. Perhaps we should pay them fairly. Now, there’s a novel idea. Why don’t our elected officials see this? Why do they fear fair and reasonable payments for something as important as medical care?

Perhaps we can find to answer in the nature of insurance itself. First and foremost, insurance is concerned with limiting losses and not paying claims. From its inception, insurance was viewed as a form of investment for wealthy individuals who were not investing to lose money. Today, health insurers operate in exactly the same manner. First deny the claim, second pay less whenever possible. When seen in this light, reducing the fees paid to providers makes perfect sense.

Now, in my own mind I make a distinction between professional fees and service fees such as those paid to hospitals, MRI centers, and so on. It is my view that professional fees should be based on usual and customary while service fees reduced to a minimum. After all, it’s the medical professionals we need working with us, not against us. I would be prepared to argue that all services should operate as medical non-profits. We should pay only the cost of the service, not a profit. But, of course, the real key is in limiting the  use of these services. Too often tests, studies, and referrals only represent waste, not services necesssary to promote health. Pay professionals fairly and limit the use of services. Allow only appropriate care based on actual clinical findings and diagnostic impression not treatment for convenience or defensiveness.