The government-induced doctor shortage

Debra J. Saunders

3/25/2002 12:00:00 AM - Debra J. Saunders
Last Sunday, The New York Times reported a story that should send a chill down the spine of every American who plans to grow old. Reduction in Medicare payments to doctors -- 5.4 percent this year, with a total decrease of 17 percent by 2005 -- apparently has prompted some doctors to refuse to take on new Medicare patients. One doctor was quoted as saying that he refuses to take new patients who are age 60 or older because they'll be on Medicare within five years. It had to happen sooner or later to the Great American Quest to Get Other People to Pay One's Medical Bills -- even when people can afford to pay them. "The funniest thing that people will say is, "I don't want to pay for it," said Harry Zeeve of the bipartisan fiscal watchdog group, the Concord Coalition. "I shouldn't have to pay for it. So let's let the government pay for it.' "Ultimately who's the government?" The government, like the enemy, is us, to paraphrase Walt Kelly's Pogo. And the government, like its citizenry, tries to get someone else to pay for medical care -- in this case, doctors. In 1997, Congress enacted a formula for what Medicare would pay for health care. One part of the formula, said a Department of Health and Human Services spokesperson, dictated that if expenses go up in one year -- and last year they were "significantly above the target rate" -- then Medicare must pay less the next year. So, if people have lots of doctor bills one year, the government pays less the next year -- regardless of the costs or need. It makes no sense, but then it's the government. Squeeze 'til you hear squeals. And the squeals must be loud. Now the squeals are relatively muted and evidence of a doctor pinch is only anecdotal. So D.C. pols feel free to suggest that seniors should get more health care from the government. They woo seniors with promises of a prescription drug benefit for all seniors -- whether they need the benefit or not. What to do? First, heed the words of former Sen. Bob Kerrey -- now a Concord Coalition co-chairman -- who told the Senate Finance Committee to shelve plans for a prescription drug benefit until Washington fundamentally reforms Medicare. "Too many citizens answer the question (of) where are we going to get the money to pay for a prescription benefit with: 'The government will pay for it.' Current beneficiaries need to understand that most of the money for this benefit will not come from them. Most of the money will come from a tax on the wages and salaries of Americans who are in the workforce," Kerrey warned. General revenue is expected to subsidize Medicare Part B to the tune of $1.2 trillion over the next 10 years. Kerrey added, "And a growing number of these workers, who are seeing an increasing share of their income going to insure someone else, do not have health insurance themselves." And people who have health insurance get doubly dinged, as hospitals and doctors shift costs from the skinflint Medicare system to private insurers. Second, alert your representatives and senators in Congress that you don't want the federal government to cut doctor fees so drastically that you'll be lucky to get a doctor who can prescribe drugs for you when you're on Medicare. Third, make it clear that you support means-testing so that affluent seniors, who don't need a subsidy, don't get one. Seniors who don't want to change the system need to ask this question: If you don't want to pay for your own health care, what makes you think someone else does? Fourth, suggest that members of Congress cut their own $150,000 a year pay commensurately if they think it's so easy for doctors to be paid less.