• Fixing the Sustainable Growth Rate

    I got a comment on my prior post on the debt ceiling deal from a commenter claiming to be the AMA:

    Frequent congressional short term fixes to the broken Medicare physician payment system have increased both the size of the Medicare cut and the cost of real reform. The new congressional debt committee will face difficult choices regarding our national debt, but to address this problem in a fiscally responsible way they must repeal the Medicare sustainable growth rate (SGR). The failed formula will trigger a nearly 30 percent cut on January 1, severely threatening access to care for seniors. Without action now, the cost of permanent reform – which bi-partisan elected officials agree is critical – will continue to escalate, increasing the cost for taxpayers. Any plan this year to reduce the deficit must repeal the SGR to keep from increasing the long-term cost of reform and to stabilize Medicare for patients and physicians.

    Now, I don’t know if it is really the AMA, but I’m going to answer it as if it were.

    I’m in complete agreement that the SGR is a real problem and that it needs to be addressed. My issue is in spinning the issue by claiming it will reduce the deficit. Make no bones about it, letting the SRG kick in would reduce Medicare spending a lot more than fixing the problem. THAT would reduce the deficit. I think that’s bad for seniors and bad for physicians, so I don’t want that to happen. But doing the right thing requires spending, not savings.

    Yes, you can make theoretical arguments about how spending more right now might save more later, but that’s not entirely clear, and it’s a nearly impossible sell in Washington, when spending on anything seems downright impossible.

    So let me be perfectly clear and repeat myself. I think that we need to fix the SGR. I think we need to recognize that it’s a long term problem and that ignoring it is no solution. I think that the short-term fixes are still expensive and waste time and money. But fixing it will require some sort of deal where revenue is raised from somewhere, through new taxes, closed loopholes, or savings to pay for the permanant doc fix.

    It’s just my opinion, but I think that the AMA would be better served by being clear about this, and not try to make it sound like deficit savings.I think the AMA would be better served by saying that sometimes good things cost money. This is one of those things. I think the AMA would also be better served by recognizing that there are some in Washington who are completely opposed to any kind of deals or spending; that’s where the focus of the AMA’s lobbying should be.

    That’s my two cents, anyway.

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    • It’s posts like this that keep me coming back to this blog — rational and honest even when it hurts.