Who'll Care for Us When Doctors Go Under?

South Korean figure skater Kim Yu Na demonstrated grace and stunning athleticism during her gold medal performance last week, in arguably the finest Olympic figure skating effort in history.  In contrast, President Obama and the Democrat leadership have shown all the grace of the ABC Wide World of Sports “agony of defeat” ski jumper during the last year. 
Nowhere is this more true than when it comes to the issue of paying doctors for health care delivered to Medicare patients.
Medicare payments to doctors make up about 40 percent of the non-hospital insurance portion of Medicare, known as Medicare Part B.  Twenty-five percent of the Part B costs are covered by premiums from enrollees, the rest from “general treasury” funds; hospital Medicare funds come from payroll taxes. Year-over-year payments for the hospital portion of Medicare change according to a formula related to the medical inflation rate.  In other words, they have increased 2 percent to 3 percent per year throughout the decade.
Medicare Part B payments, on the other hand, have been tied to an arcane and bureaucratically inspired formula since 1997 known as the “sustainable growth rate.”  Since 2001, the real inflation-adjusted payments under Part B have decreased well over 10 percent, and many specialties have seen far greater cuts. 
These cuts would have been even larger, except Congress has acted to block the cut every year since 2002.  Yet the underlying formula laid out back in 1997 remains unchanged, and the current planned cuts are 21.2 percent for this year, along with about 5-percent cuts for the next few years, all not including inflation.
It is fair to say that, rightly or wrongly, many doctors will go out of business, and many more will cease to participate in Medicare and Medicaid (where payments are most often tied to Medicare rates) if these cuts occur.  If health care reform is, in fact, supposed to increase access to health care AND promote quality care, this downward path is unsustainable.
But in Washington, the cost of paying doctors for actually providing care is not being considered as part of reform.
Americans understand this to be absurd.  It is the same as my dismissing the impact of rent or a mortgage on the family budget, simply because it is inconvenient for the numbers.
Democrats and pundits have engaged in intellectual gymnastics worthy of a medal in trying to explain why they should not have to account for the cost of fixing the doctor payment schedule in their reform plans – while at the same time relying on the phantom cuts to demonstrate how $2.5 trillion in new spending actually cuts the deficit. The Washington Post’s Ezra Klein wrote on March 1, “The [doctor payment] problem predates health-care reform and exists irrespective of health-care reform’s fate. Attempts to lash the two together are nonsensical.”
Only in Washington, where the oft-repeated goal of the president has been to “reform health care” to save the country from deficits, can you simultaneously ignore problems that began before you came into office while at the same time using those problems as justification to push new huge programs of your own.
The real reason Democrats are pretending that paying for care is not part of health care is the cancerous effect of power, authority and the ability to spend wealth others – from gardeners to teachers to entrepreneurs to big businesses – have created. 
Addressing the Part B formula so that health care providers will actually be there in the future to, well, provide health care, will cost at least $250 billion over 10 years. The magic “health care reform decreases the deficit by over $130 billion over 10 years” relies on not including that figure in the calculations.  The cuts are not going to go through—every Senate Democrat voted to block the cuts, and became apoplectic at a delay of the vote by even one day.
The president spoke recently about Congress coming together with an Olympic-like spirit to “get health reform done.”  Mr. President, Speaker Pelosi, and Senator Reid – the Olympics are about honest effort, honest scoring, and honest results.  Denying reality does not work in Olympic competition, and it does not work in health care.  If you plan on attempting to ram through a health care bill, at least have the decency to tell the American people – and our doctors – what the real costs will be.