From Left and Right; Opposition to Flawed Medicare “Doc Fix”

The U.S. Senate will have to deal with the flawed so-called Medicare “doc fix” Wednesday at the latest, if doctors are not to suffer a significant drop in their payments from Medicare.

Voices from both right and left have discovered serious problems with the bill, and proposing solutions. Here are three examples:

According to Robert E. Moffit and Paul Winfree of the Heritage Foundation, writing at The Hill,

In addition to guaranteeing taxpayers hundreds of billions more in future indebtedness, the House bill carries huge opportunity costs. America needed robust, bipartisan structural Medicare changes—reforms that would significantly improve the program and secure serious long-term program savings.  Unfortunately, the back room deal merely tweaks existing “means testing” for premiums charged to Medicare’s wealthiest (top 6 percent) recipients and, beginning in 2020, limits “first dollar” Medigap coverage to the modest Part B deductible.

The National Review editorial board similarly challenges the bill, in the print edition dated April 20,

In this case, the bill is a fiscally irresponsible effort that pleases most of the powerful interests involved in the issue.

Given the leverage the doc-fix situation provides, the Republicans should have held out for a fully paid-for doc fix and real reforms to Medicare.

It is not a disaster, but it is a missed opportunity, and a bad sign for how serious Congressional Republicans are about entitlement reform.

And, from Professor Ted Marmor of Yale University, an advocate of single-payer, government-monopoly, health care, writing at the Philadelphia Inquirer,

The celebration of paying for “value over quantity” assumes we know how to identify value and pay for it. Yet, there is considerable disagreement in modern medicine about how much one way of working is better than another.

For example, an attempt to establish a standardized cost-benefit analysis of treatments for Medicaid patients in Oregon in the late 1990s fell apart upon implementation. There was no agreed-upon list of what treatments were more valuable on grounds of both cost and quality, and physicians were rightfully indignant when their professional knowledge about what was best for their individual patients was upended by a rulebook.

In reading the bill that the Senate will soon vote on, I can’t help but notice how the new prescriptions for physician behavior represent marketing jargon more than considered thought.

Ouch.

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