• Tone deaf?

    We all know what the doc fix is, right? The annual (or so) vote to not let the SGR kick in so that docs don’t see a massive cut in their Medicare reimbursement? The AMA thinks that the debt ceiling negotiations are the time to make the fix permanent:

    Republican negotiators have poured cold water on the idea of using the debt-ceiling vote to tackle the “sustainable growth rate” formula (SGR). But the American Medical Association and other doctors groups say the two go hand-in-hand.

    The SGR has become a perennial headache for doctors and Congress alike. The formula calls for a payment cut of nearly 30 percent in January 2012 — when the latest temporary fix is set to expire. Congress consistently blocks scheduled cuts from taking effect, and has to come up with new offsets each time.

    According to the AMA, a permanent SGR repeal would have cost $48 billion in 2005 — compared with a price tag of nearly $300 billion to block the cuts that are scheduled for January.

    Do you really think that negotiations concerning the debt ceiling are the time to start arguing for an additional couple of hundred billion in spending? Really?

    Raising the debt ceiling is incredibly important. Negotiations aren’t going totally smoothly. Evidently, cutting spending seems to be the one thing that both sides can sort of agree on.

    Demanding that new spending be part of the the deal isn’t going to go over well with either side. It’s not going to happen. Moreover, demanding it might make your group look silly. There are times to argue for more spending, and I’ve done so many times, but as part of a negotiation to lower the debt ceiling? That seems a bit tone deaf.

    • The debt ceiling is not the time or place to negotiate anything. It is the result of the budget… taxing and spending legislation passed by congress which IS the time and place to be negotiating about taxing and spending.

    • Aaron
      Whether this round of negotiating will fall flat, no one knows, but if it does, we will get a several month extention on the debt ceiling (I think. I hope). Prolonging the day of reckoning pushes the SGR deadline closer (Jan).

      The issue is not the cost, although significant, but doing something about it and finally casting this aside once and for all (or at least until tne next generation of payment is implemented).

      In the context of a deficit package worth 2+trillion dollars, several hundred billion is not small change. It must be dealt with, and while circumstances not optmal, and here’s the thing–they wont get better. It is do it now, or push it off to an even more inconvenient time.

      This isse has been lingering for so darn long, that even the lawmakers who are woefully uninformed on health care issues know its a ball and chain.

      I dont see the incoherance here. Fix it. Again, its not about amping up salaries, its about repairing something that will not disappear and has costs attached.


    • Unsure what Aaron thinks should be done here. No doc fix now and you think it won’t have an effect on coverage for medicare recipients come January?

    • Does the SGR apply to hospital fees or only to doctors?

      1. The doc fix is not renewed in January, 2012, allowing the SGR to take full force.
      2. Doctors (some, perhaps a majority) refuse to take medicare patients.
      3. Seniors storm (figuratively, at least, perhaps literally) the halls of Congress.
      4. Then what? Congress renews the doc fix? Congress repeals SGR? Something better than either of these alternatives? What is the solution to the current SGR problem?

      • @ Adam

        It seems to be that the inevitable outcome of all this will be a legislative mandate for physicians to treat medicare patients on the reduced fee schedule, followed by backlash from doctors, followed, many years down the road, by socialization of medical education to bring us more in line with Europe. In the meantime, however, all we will get is screaming.

    • Yes, Mark, the best thing would be to enact a clean debt-limit increase. And yes, Aaron, it does look self-serving for the AMA to be making this point now. But that doesn’t mean that they’re entirely off-base.

      The issue is this. To secure passage of the debt-limit bill, it may have to include some deficit-reduction provisions. There is also political pressure that any doc fix be fully paid for, quite possibly by cuts in Medicare spending (although no one has a decent idea for getting that much savings). Under these circumstances, you don’t want to use up all your Medicare savings for deficit reduction and not have any reasonable cuts left to pay for the doc fix.

      The unnamed “Republican negotiators” might be happy to slash Medicare twice, but the docs are right to worry about that scenario.