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Max Baucus Requires Health Care Rationing

And Probably Leads to Something that Rhymes With "Shmeath Ranels"

By: Brian Faughnan (Diary)  |  October 1st, 2009 at 04:30 PM  | 

RESIZE: AAA

The Washington Times recently took a look at the forced health care rationing in Chairman Max Baucus’s health care overhaul legislation:

The offending provision is on Pages 80-81 of the unamended Baucus bill, hidden amid a lot of similar legislative mumbo-jumbo about Medicare payments to doctors. The key sentence: “Beginning in 2015, payment would be reduced by five percent if an aggregation of the physician’s resource use is at or above the 90th percentile of national utilization.” Translated into plain English, it means that in any year in which a particular doctor’s average per-patient Medicare costs are in the top 10 percent in the nation, the feds will cut the doctor’s payments by 5 percent.

Forget results. This provision makes no account for the results of care, its quality or even its efficiency. It just says that if a doctor authorizes expensive care, no matter how successfully, the government will punish him by scrimping on what already is a low reimbursement rate for treating Medicare patients. The incentive, therefore, is for the doctor always to provide less care for his patients for fear of having his payments docked. And because no doctor will know who falls in the top 10 percent until year’s end, or what total average costs will break the 10 percent threshold, the pressure will be intense to withhold care, and withhold care again, and then withhold it some more. Or at least to prescribe cheaper care, no matter how much less effective, in order to avoid the penalties.

This is a highly arbitrary and pernicious way to cut medical care for seniors. The Baucus approach penalizes the top ten percent every year. There is no target level of spending, after which the penalties sunset. Further, no provider ever knows if he or she is likely to end the year in the top ten percent. For that reason there is an incentive to cut costs on every patient, every procedure, every expenditure, on every day of the year. And if a doctor finishes the year in the bottom 90 percent, the average level of spending will have been reduced, and there will be a new contest to cut further, to remain in the bottom 90 percent the next year.

In practical terms, there’s probably some point at which further rationing becomes politically impossible. Once Medicare expenditures and reimbursements are sufficiently reduced, once the federal government has adopted Oregon-style death panels to deny expensive care to the aged and infirm, Congress will likely have to step in to stop the ‘death spiral.’

Another likely effect of this change would be to encourage doctors to shift more costs from Medicare to private plans. If there is an ongoing incentive to reduce spending on Medicare patients, caregivers will try to cost-shift to those on private plans. That will have the added effect of driving up health insurance costs.

Every Democrat on the Finance Committee voted to preserve the Medicare death spiral. Kent Conrad voted for it even as he recognized why it’s a bad idea:

As National Right to Life Executive Director David N. O’Steen, Ph.D., has previously noted, “It’s like a game of musical chairs, in which there is always one chair less than the number of players – so no matter how fast the contestants run, someone will always be the loser when the music stops.”

Although Senator Kent Conrad (D-ND) voted against the Kyl Amendment because he disagreed with its budget offsets (required under the committee’s rules), he earlier said, “As I try to put my feet in the shoes of a doctor, I don’t know how you separate out overutilization that is really overutilization. There is no way of knowing when you go through the year, what you are going to do at the end of the year.” He warned that the provision could come back to “haunt us” in a few years.

The Senators who voted to keep this provision are:

Max Baucus, MT

Jay Rockefeller IV, WV
Kent Conrad, ND
Jeff Bingaman, NM
John Kerry, MA
Blanche Lincoln, AR
Ron Wyden, OR
Charles Schumer, NY
Debbie Stabenow, MI
Maria Cantwell, WA
Bill Nelson, FL
Robert Menendez, NJ
Tom Carper, DE

If you’re a constituent, you might want to ask why.

Via Protein Wisdom

Cross-posted to theconservatives

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COMMENTS

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  • azred

    Let’s cut off 5% of the top 10% every year. So 1 out of 10 doctors will get docked every year. A built in cost model to push costs down, no matter what the cost of doing so.
    Eventually, you eat your young to survive, but you still keep costs down.

    I’ve got an idea – let’s just outlaw the practice of medicine other than administering aspirin. All other forms of medicine are illegal. Everyone can get aspirin for free. No copay. Illegals, step on up. Why stop at crippling the HC system. Let’s just ban it. That will save so much more money to spend on other more worthy pork er… needed legislation.
    /sarc

  • tgharris

    After all, these senators will be bound by the same health care rules we average folks are…..right?

  • gahazzah

    I’ll explain.

    (R)s claim to be against Medicare as it is bankrupt and inefficient and so on and so forth (insert Constitution here for those who’ve read it and believe in it).

    This plan would –

    1) Cut spending in Medicare every year regardless of year thereby driving down the costs of Medicare.
    2) Force people to find alternative ways to pay for their health care instead of simply relying on Medicare (as it will get worse and worse).
    3) Force doctors to stop taking Medicare payments as it will become all but worthless to them with treatments costing more than their reimbursements.

    (R)s should be trying to trick (D)s into passing this little nugget on it’s own or as an amendment to another bill. It’s the best cut in Medicare I’ve ever seen because the doctors take the blame for the cuts and therefore career politicians can skate on.

    • The_Gadfly

      3) Force Increase the rate at which doctors to stop taking Medicare payments as it will become they are all but worthless to them with treatments costing more than their reimbursements.

      A fair percentage of doctors have already stopped taking Medicare payments for precisely those reasons.

  • sarge324

    i cant believe we have senators who went along with that.seniors are going to be wiped off the face of the earth.the top ten percent is going to be seniors.and they dont care.am doing everything in my power to vote my congressman and senator out of office.

  • bk

    It seems the Baucus bill is at least honest in saying that illegals are due free care, the middle class will pick up most of the tab, there will be cuts, there will be rationing, etc. The others try to hide most of this.

    The GOP needs some way to highlight all the bad things in Baucus’s bill and make it clear that they are 100x worse in any of the non-Baucus bills.