I just don’t know what to say

I’m feeling tired, due to a cold, and having trouble generating much energy to retype the same things. But I’ll try.

Here’s Mary Agnes Carey and Christopher Weaver from KHN:

In his fiscal 2012 budget plan released Monday, Obama proposed a two-year, $54 billion solution to stop the [Medicare physician] payment cuts, which otherwise would go into effect Jan. 1. To finance what insiders call the “doc fix,” the president would reduce waste, fraud and abuse and draw on savings from a variety of sources, including the states, drug makers – even power wheelchair retailers. […]

[S]ome state officials complained about the impact on Medicaid, the state-federal health program for the poor and disabled. Obama’s plan would cut $18.4 billion in federal Medicaid funding by reducing the amount that states could tax providers, such as hospitals, to help finance Medicaid.

Such a restriction on provider taxes would reduce the amount that states could collect in taxes and spend on Medicaid. That, in turn, would lower the amount that the federal government would have to put up to match the state funds.

With lower provider taxes, states would be able to “extract less from the federal government,” explains Edwin Park of the nonprofit Center on Budget and Policy Priorities.

Obama, in trying to solve the doctors’ payment problem, also proposed steps to increase the use of generic drugs. That would make drug purchases for federally funded programs less expensive. But the Pharmaceutical Research and Manufacturers of America, the drug industry’s main trade group, said the proposal would hurt the industry’s ability to innovate. […]

Some analysts predicted the payment fix would get little traction on Capitol Hill as lawmakers focus on the broader problem of finding ways to cut the budget and reduce the deficit.

“I don’t think anything meaningful will come from any of this,” said Gordon Wheeler, associate executive director for public affairs at the American College of Emergency Physicians. “The intensity of the debate right now is on the debt and the deficit.” […]

The issue has widespread political implications. Physicians threaten to stop seeing Medicare patients if reimbursement are cut. Seniors, a powerful voting bloc, fight back against any Medicare reductions. And Obama and Democrats are already on the defensive after cutting more than $450 billion over the next decade as part of the health law.

Aarrgggggg!!! This is a great story only in the sense that it illuminates the unbelievably complicated state-federal-private web of interests and political maneuvering. Anyone who wants to do anything in health care has got to deal with the politics. They’re real and they’re a major — even the most important — factor in explaining why things are the way they are and in what ways they could possibly change, by how much, and how fast.

Have a great way to improve the health system or its financing? Until you satisfy all or most of PhRMA, physicians/AMA, Medicare beneficiaries, AHA, the states, AHIP, etc., it’s not happening even if it is the most rational thing on the planet. Politics matter. A lot.

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