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.
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