A reader writes:
I certainly agree with you in theory, however, in reality I have to tell you that I am really nervous. I am 64 and am currently employed and have insurance. I am retiring in January and will continue with my current insurance until April when I turn 65 at which time Medicare kicks in. Here’s the rub. I wanted to change docs and guess what the first question was when I gave them my date of birth. You got it what insurance do you have? Hmmmm wonder if they would have taken me as a new patient (or will keep me) when I am on Medicare. Asking the docs to take a 20% hit on Medicare patients is not exactly incentive to take anyone over 64. Do you have an alternative suggestion?
Another writes:
The Medicare bill that failed yesterday was far from a bribe. It was an attempt to fix an accounting error that could cripple the primary care system for seniors.
The Sustainable Growth Rate formula that determines payments to physicians (but not to hospitals) has required physician payments cuts for the last several years. The formula is complicated, but one of its biggest flaws is its failure to account for the rapid rise in the costs of providing care. Congress has understood this for the most part and voted to stop smaller scheduled cuts many times before. Many physicians are small business owners, and when their costs are rapidly rising out of their control and their payment is being forced downward, they often stop taking Medicare patients or adjust their practice styles in other ways.
The difference between yesterday’s bill and previous interventions was that instead of just passing a one-year fix, Congress was finally trying to find a long-term solution. The can has been kicked down the road so long that physicians are facing a 21% cut in Medicare payments in January. That won’t happen because it would be disastrous to the healthcare system. The shock of such a financial hit alone would be disruptive, plus you’d probably have a lot of physicians dropping Medicare. Instead, once again Congress will slap a Band-Aid on the SGR, freeze payments for one year to avoid a 21% cut, and have to address the problem again and again and again until a long-term solution is found.
The politics of it were indeed sketchy, and you’re right in calling for pay-go funding, but I thought you might be interested in some in-the-weeds details about why the bill mattered in terms of policy.
Just find a way to pay for it, that's all.