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.
- 1
- 2
It seems as if there is absolutely no accountability once politicians are elected. We are seeing one big drawback to electing a newcomer, lack of clarity of intent.
Politicians will say or promise anything to get elected, but the truth is that it costs so much to run for office now that the huge corporate special interests largely decide who runs and who wins. And politicians are indebted to them. They control the agenda. As I understand it the European model includes a referendum mechanism allowing elections to be called and voters to recall legislators if they turn out badly, or even if they fail to act decisively to protect the public interest in a crisis.
But no such referendum option exists here, four years is exceedingly long, in the modern context, and the joke ends up being on us when we elect politicians who look good but who can't or won't fulfill the hopes of those who elected them..
How did this fiasco on healthcare develop? What gives legislators the right to play these games while so many people are dying?
Its not what the people need or want.
#1 Posted by John, CJR on Fri 23 Oct 2009 at 07:49 PM
A bit too much vilification of "docs," oversimplifying physicians as some homogenous group with a uniform and consistent interest. The qualifier, at least those represented by the AMA, is a disqualifier, as the AMA represents ~ 25% of physicians. Granted the various specialty societies function as guilds, but to decry physicians' attempts to prevent a 21% cut on Medicare reimbursement, is to ignore a substantial number of physicians who continue to serve Medicaid patients despite reimbursement that is so low that some subsidy is required from somewhere.
I certainly hope that you look at how medical education is financed, what the debt is that the average physician graduates facing, and how despite this, physicians still turn to careers of service out of commitment to a profession rather than cupidity.
Obviously, Single Payer is the answer, and if that isn't to be this time around, then a public option retains the faintest hope of some level of restraint in a profit driven system.
#2 Posted by Laurence Lewin, M.D., CJR on Tue 17 Nov 2009 at 10:32 PM