After a July 4 holiday recess, U.S. Senate Majority Leader Harry Reid plans to force another vote on an important piece of Medicare legislation that breezed through the House of Representatives on June 24 but then stalled in the Senate, falling one vote shy of the 60-vote requirement for passage. (Had Sen. Ted Kennedy not been ill, the bill would be on its way to the president.)
The Democratic Party-engineered legislation would stave off a 10.6-percent cut (required under a previously agreed-upon formula) in the amount of money the government pays doctors back for services rendered under Medicare. Congress has been heading off these cuts in payments for years, but this time the Democrats want to balance the books by cutting the amount of money the government pays private insurers to offer so-called Medicare Advantage programs—health plans for seniors that offer expanded services over standard Medicare—and most of the Senate Republicans balked and voted no.
Mindful that doctors groups, as well as advocates for seniors, are with the Democrats, I wanted to hear a critique of the system straight from a doctor's mouth. With the help of the San Diego County Medical Society, I connected with Ted Mazer, an ear-nose-and-throat guy who says he's been involved in the Medicare fight for seven years.
Mazer, a Republican, said he has no problem with private payers being in the Medicare business as long as they're getting the same amount of taxpayer money as doctors who are paid directly by the government. But that's not the case, he said—the government's paying the insurers 112 to 119 percent of the amount it would be paying for standard Medicare. Meanwhile, the reimbursement rate for standard Medicare is barely above cost, Mazer said. If the required cuts are allowed to proceed, he said, doctors will be receiving reimbursements equal to 1994 levels.
“And you can be sure that no doctor's office is paying 1994 salaries and 1994 overhead,” he commented.
The way he tells it, Medicare Advantage plans came from a Republican desire to privatize aspects of the Medicare system and see if additional services could be delivered at the same cost—or slightly more to cover some marketing.
But Congress has ramped up the amount paid into the private system, and Mazer believes those companies are profiting handsomely. On the face of it, he said, it's not fair for taxpayers to be subsidizing those profits when the lion's share of Medicare beneficiaries are still in the standard plan. (According to Wikipedia, 19 percent of those enrolled in Medicare are enrolled in the private system.)
That's why he'd like to see the Senate and the president get on board with this legislation—to level the playing field between the private and standard systems. But that's just a start. The formula for determining the reimbursement rates is universally considered flawed, Mazer said, so the feds simply need to “normalize” the formula so that Congress doesn't have to go through this rigmarole every six months. But, like with so many vexing issues, no one is demonstrating any leadership.
San Diego, he said, is worse off than anywhere else in California. Thanks to outdated formulas in what's known as the Geographic Practice Cost Index, San Diego County is considered rural, rather than urban, meaning doctors here get the same amount for services as doctors in the Northern California mountains or the Imperial County desert, despite the higher costs. Ten other counties are disputing their designation, and it would take just $50 million a year to make that right, he said, calling that figure “budget dust” when compared with the trillion-dollar federal budget.
Because I'm opposed to privatization of basic services (education, healthcare, water, energy, etc.), this guy is singing my tune, but I'm certainly aware that doctors have a dog in this race, so I asked Mazer about the public perception of doctors and how that differs from reality. He said he believes the public largely thinks physicians are still rolling in dough.
There's no doubt that doctors are paid above-average wages, but take-home pay has been decreasing through the years. Couple that with all the years of education and residency, and all the debt from medical school, and it's getting to the point where no one's going into primary-care medicine anymore. The situation's not as dire for specialists, he said, but as for basic healthcare, it's a changing world.
“There is not a future in primary-care medicine,” he said. “Today, you can go see a doctor, but in 10 years, the likelihood is that when you want to go in for your stuffy nose or your achy back, you're going to go to a CVS pharmacy and see a nurse practitioner, because there won't be anybody in San Diego to see you.”
My conversation with Mazer barely scratches the surface—this Medicare business is complicated stuff. If I never had to think about this again, I'd be a happy man.