Both the Wall Street Journal, in the lead editorial, and Dana Milbank in the Washington Post address the Democratic Congress/Obama Administration attempt to buy physician support for their vision of health care reform this morning. First, from Dana Milbank:
Senate Democrats wanted to protect doctors from scheduled cuts in Medicare payments over the next 10 years, but there was a problem: Doing so would add a quarter of a trillion dollars to the federal deficit, making mincemeat of Obama's promise. So Democrats hatched a novel scheme: They would pass the legislation separately, so the $250 billion cost wouldn't be part of the main reform "plan," thereby allowing the president to claim that that bill wouldn't increase the deficit.
Republicans, who had been losing traction in their effort to fight a health-care overhaul, could hardly believe the gift the majority had given them.
"I have never witnessed something more sinister!" an agitated Sen. Bob Corker (Tenn.) declared on the Senate floor Tuesday morning. Citing a report that the "doc fix," as the $250 billion measure is called, was created to buy the American Medical Association's support for the main health-care bill, Corker accused the AMA of prostitution. "We all know that the selling of one's body is one of the oldest professions in the world," Corker said. "The AMA is engaged in basically selling the support of its body."
I like Sen. Corker's metaphor. It's vivid. Mr. Milbank demonstrates later that he doesn't quite have a full grasp of the problem of the SGR.
A decade ago, Congress passed legislation designed to limit health-care costs by slowing the growth of Medicare payments to doctors. Each year, Congress passes a "patch" to prevent the cuts from taking effect. Stabenow proposed to make this system "honest" by eliminating the cuts permanently.
Medicare is hurtling toward insolvency, but Stabenow would essentially repeal past cost-cutting efforts. And even granting that it's a good idea not to cut Medicare payments to doctors, it's a strange interpretation of honesty to separate this $250 billion cost from the health-care bill and then claim that the other bill doesn't raise the deficit
Well, which is it? Are we "slowing the growth" of payments to doctors, or are there actual cuts? Which refers to the actual fees paid, and which to the global budget? The short explanation, for Mr. Milbanks edification, is that the SGR was supposed to slow the growth of the overall Medicare budget; to do so the SGR would require cuts in the already bargain basement rates for individual procedures by individual physicians, thus making medicine the only deflationary service industry in the world.
The WSJ comes up with several clever turns of phrase to establish the points.
So now Democrats are simply going to "untether" this spending on doctors from ObamaCare, hiding even more of its true costs. At a meeting on the Hill last week, Mr. Reid and White House Chief of Staff Rahm Emanuel made the quid pro quo explicit, telling the AMA and about a dozen specialty societies that in return for this dispensation they expect them to back ObamaCare, no questions asked.
It turns out the AMA is a cheap date. President J. James Rohack now looks ready to embrace whatever else Democrats offer up, even though the new bill only delays the SGR cuts for 10 years instead of doing away with the formula permanently. Never mind that the AMA's other legislative priority—tort reform—is dead on arrival. ObamaCare is stocked with other provisions that punish doctors ...
Like other industry lobbies, Mr. Rohack seems prepared to trade away his members for a sack of magic beans. ... [T]he least the AMA can do is use its political leverage for something more lasting than a 10-year promise that is bound to be revoked when ObamaCare's costs run off the rails
Again, I can't be bought. Earlier I tried to emphasize that cost is a bit of a red herring, in that getting the costs right at the expense of the greatness of American medicine is no bargain. Doing so dishonestly in a way that doesn't control costs would be even worse. Further, in this instance the AMA certainly doesn't represent me. They may be willing to trade their support for ObamaCare for short money; I'm not willing to trade it for long money, because of the inherent contradictions that will lead to deterioration of the system.
10/21/09 0905: Hmmmm. Perhaps the AMA has a backbone, he muses optimistically?
Yet the AMA won't yet pledge support for the major health care bill that is the chief objective of the White House and congressional Democrats, despite a request that several officials say was made at a meeting last week with Senate Majority Leader Harry Reid, D-Nev.
Nor does it seem eager to soft-pedal another of its own top priorities, legislation to restrict medical malpractice payments.
"We continue to press for significant medical liability reform because we know that is a very important contributor to unnecessary health care costs," Dr. J. James Rohack, president of the AMA, said in an interview in which he declined repeatedly to say whether the organization had been asked to back off.
Higher payments to doctors and curbs on medical malpractice awards "in my mind are separate issues. I can't speak for how other people are putting this whole thing together," he added.