Who Will Be at the Table, Part XVII

The docs are back for their piece of the pie

During the campaign, Barack Obama promised his cheering crowds that, when he rolled up his sleeves to work on health care, he would have “insurance company representatives and drug company representatives at the table. They just won’t be able to buy every chair.” Now is the time to look at what kinds of seats special interest groups are having at Obama’s table and what they’re doing to bring the public around to their ways of thinking. This is the seventeenth of an occasional series of posts that will analyze their activities and how the media are covering them. The entire series is archived here.

Doctors have been something of an enigma this lobbying season—at least the ones still represented by the American Medical Association (AMA) and all those specialty groups that look out for the heart docs, the orthopods, and the derms. What with their loose agreement to support reform and to ensure every person is covered, albeit by making them buy private insurance, it has been a “go-figure” kind of year.

As Campaign Desk has reported, the media have portrayed the docs as the white hat guys, partly because journalists have taken their cues from politicians and advocacy groups that early on decided insurance companies were easier to demonize than doctors. Doctors, after all, have a reputation for curing people; insurers have a bad rep for denying them care.

But wait a minute—doctors are hardly blameless for the health care mess. They are the ones who perform unnecessary tests and procedures, make life-threatening mistakes, and play games with billing codes to pad their fees, which in turn help send overall medical costs into the heavens. It seems their real reason for being so agreeable this year is that the individual mandate will mean more patients with insurance to pay their bills. And get this—until yesterday afternoon, they considered it almost a sure bet that fee cuts planned under the Medicare program would be stopped cold. For eons, fee cuts and lower incomes have been poison to the profession.

Despite heavy lobbying by the docs and the Democrats’ willingness to help them out, the Senate yesterday killed a bill that would have blocked those odious fee cuts for good, paving the way for higher incomes at government expense. Shortly after the vote, the Wall Street Journal’s health blog reported that it was back to business as usual for the docs and Congress, which would most likely pass a one-year fix like it has always done. That means the planned cuts are blocked for one more year, giving the nation’s physicians another grace period. Whew!

That’s all the more reason the public needs to know about the drama on Capitol Hill this week—the Democrats’ intended maneuver to stop the fee cuts and ensure that the doctors will be smiling at the bill signing party. The saga of the fee cuts is instructive, for it shows why the U.S. has been unable to stop medical inflation, and it defines the hypocrisy and contradictions laced throughout this year’s debate. While “affordable health care” has been the mantra of the president and his fellow Dems, the party of the people is making that goal hard, if not impossible, to reach by sparing the docs from the Medicare fee reductions. “Unbelievable” is how blogger Robert Laszewski put it in his posting on Health Care Policy and Marketplace Review.

In 1997, as part of something called the Balanced Budget Act, Congress established a schedule of fee cuts designed to lower what Medicare pays physicians. While those cuts might actually have bent the proverbial cost curve, doctors pushed back. The cuts stung them big time because Medicare payments make up, on average, about one-third of doctors’ incomes and are the trend-setters for what private insurers pay.

So throughout the past decade, the AMA and other doctors’ groups have successfully waged war on the cuts, lobbying ferociously and getting reporters to write favorable stories about how cuts will hurt patients. This year they not only hoped to stop the twenty-one percent cut scheduled in January, but believed they could eliminate the cuts permanently, giving them a $247 billion gift over ten years from the U.S. Treasury. University of North Carolina health policy expert Jonathan Oberlander characterized the AMA’s amenable behavior as “the price for admission” to the side of a debate it has never joined before—the side of “yes.”

The public needs to know whether that price is too high, given the reality that only those with good incomes can afford health insurance, and that all the talk about affordable care is well, just blah-blah rhetoric. Letting doctors off the hook for doing their share to control costs, it seems, gets to the heart of what this whole debate has been about—but the media have failed to connect the dots. There have been too many stories from the Washington press about the doctors jockeying for the permanent fee cut, and too few about the docs’ role in causing medical inflation and its link to the fee cuts. The next round of stories will probably offer endless speculation about whether the doctors will still be at the table.

The Washington press has chronicled the horserace—an amendment from Senator So-and So, a comment from the AMA, a rebuttal from a policy wonk. But what the public needs to know is that unless the U.S. comes to grips with the underlying cost of medical care—what the doctors and hospitals charge—insurance premiums will remain unaffordable. It’s as simple as that.

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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.