The Doctors and the Disabled

Have the doctors won on fee cuts?

The American Medical Association was positively gleeful after the House bill passed, quickly issuing a statement on its Web site that gave the group’s spin on the legislation. “The AMA hails the passage of the House health reform bill,” the statement began. “Passage of the House health reform bill is a big step forward as we work for comprehensive health reform this year.” But it was the last graph that was most telling.

As Congress considers new coverage commitments to the American people through health reform, it must ensure that commitments already made are fulfilled through passage of the Medicare Physician Payment Reform Act of 2009 (H.R. 3961). This bill will permanently repeal the broken physician payment formula and preserve access to care for seniors, baby boomers and military families.
The docs agreed to support health reform—no negative ads, no obstructionism this time—as long as Congress agreed to cancel the fee cuts that it had originally enacted a decade ago to begin slowing the growth in Medicare. Real cost containment, not the faux stuff that’s in the bill. Over time, those cuts would mean less money for the docs, many of whom are already near the top of the income ladder. A few weeks, ago the Senate killed a bill that would have blocked the Medicare fee cuts once and for all. The AMA’s message Saturday night was: The House had better not do the same.

Last week, as the crucial House vote approached, the AMA issued a press release that “announced support for concurrent passage of H.R. 3962 and H.R. 3961, U.S. House of Representatives health system reform bills.” Concurrent was the operative word, wrote blogger Robert Laszewski on Health Care Policy and Marketplace Review. In other words, the docs were happy to support the House Democrats if the fee cuts were banished for good. Eliminating the fee cuts means that the U.S. Treasury will give higher fees to the doctors to the tune of $210 billion over ten years, according to the latest CBO estimates. That’s nearly twice as much as it would cost to provide coverage for the disabled without the current Medicare waiting period.

Some, but not all, in the media understood that the doctors’ endorsement came with qualifications. The Wall Street Journal reported that AMA president J. James Rohack noted that Congress can’t fix the health care system without also passing a bill that stops the fee cuts. A twenty-one percent cut goes into effect next year. and the docs are bound and determined to stop it. said the AMA supported the House bill, “but with a big blinking asterisk.” Forbes reported that, on a conference call last week, Rohack said that the bill deserves support only if Congress also passes a separate bill that increases Medicare reimbursements to doctors. But so far the media haven’t explored other uses for the taxpayers’ money—like allowing poor, disabled people to get Medicare coverage right away.

Here we have a story of a powerful and influential organization with money to spread around competing with a grassroots advocacy coalition representing people who don’t have a voice in the political process. This is one time where the adage “follow the money” leads away from the real story.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.