When will John Boehner learn that a bill is bad news if Nancy Pelosi supports it, President Obama wants to sign it, and the press sings its praises? That’s precisely what he had on his hands with H.R. 2, the Medicare Access and CHIP Reauthorization Act, a.k.a. the “Doc Fix.” Yet today we find him basking in the approbation of the Beltway establishment for getting this bill passed. This “fix” will add billions to the federal deficit, replace an unworkable price control system with a worse scheme that will dictate how doctors practice medicine and place financial burdens on seniors.
To give Boehner his due, the impetus for this bill came from a laudable desire to repeal the Sustainable Growth Rate (SGR) boondoggle signed into law by Bill Clinton in 1997. Ostensibly meant to control Medicare spending, SGR was never workable because it would have held physician payments to a rate that failed to keep pace with rising costs. It would have amounted to a de facto annual pay cut and discouraged doctors from accepting Medicare patients. Congress consistently shrank from enforcing it, while physician groups relentlessly lobbied for a “permanent fix.”
Last week’s legislation finally provided that, but its contents suggest that Boehner is no better at negotiating with Democrats than the President is at dealing with Iran. In his zeal to produce a bipartisan bill, Boehner abandoned all pretense of fiscal responsibility. He reversed his position, for example, on how to pay for SGR repeal. When he was Minority Leader, the Daily Caller reports, “Boehner slammed Pelosi for proposing a fix to the SGR without offsetting the cost.” He called Pelosi’s doc fix “irresponsible,” but his own “bipartisan triumph” includes little more than a fig leaf of funding.
Even worse, Boehner included another unfunded deal sweetener in the form of a reauthorized Children’s Health Insurance Program (CHIP). CHIP is, in theory, not a permanent entitlement. But it has been consistently reauthorized because establishment Republicans are afraid they will be accused of killing children if they don’t obediently authorize the spending required to keep it going. The cost of CHIP, combined with that of the Doc Fix, is of course a matter of debate. However, the Committee for a Responsive Federal Budget says this bill “would add over $500 billion to the debt by 2035.”
Ironically, this expensive Doc Fix doesn’t really provide physicians very much relief. As Medical Economics reports, “The proposal calls for annual reimbursement hikes of 0.5% from 2014 through 2018.… it doesn’t take a macroeconomic expert to realize that a 0.5% annual payment increase lags inflation, which generally has hovered around 2% to 3% over the last few years.” Even worse, beginning in 2019, Medicare payments to physicians will be frozen for six years. Yet the AMA applauded this “fix” and encouraged the Senate “to approve the policy and send it to the President’s desk.”
The AMA has, of course, long since ceased to be the voice of the medical community. It now represents only a fraction of practicing physicians, largely due to the betrayal of its membership on Obamacare. Among doctors who actually treat patients, there is considerably less enthusiasm for this bill. No one will miss the late unlamented SGR, of course, but many are as disturbed by the red tape proposed in this “fix” as they are about the regulations imposed by PPACA. There is very real concern that H.R. 2 will seriously restrict physician autonomy while contributing little or nothing to patient care.
This concern involves the bill’s establishment of a Medicare payment structure that allegedly emphasizes quality over quantity. That sounds reasonable. But, in practice, such reimbursement schemes tend to reward documentation skills rather than quality of care. Neurologist M. Todd Williamson, a former President of the Medical Association of Georgia, puts it thus: “Government monitoring of so-called ‘quality measures’… will not improve patient care, but it will increase practice overhead with administrative busywork and it will distract doctors from their patients’ real needs.”
Cardiovascular surgeon Patrick Roughneen shares Dr. Williamson’s concerns. In the Daily Signal Dr. Roughneen writes, “Not only is the bill extremely costly, but it is also flawed in its design… H.R. 2 would require [doctors] to comply with burdensome checklists and documentation requirements in order to receive payment.” Such wasted motion will slow physicians down and reduce the number of patients they can treat. This, in turn, will make it harder for Medicare patients to get doctor appointments, a problem that already bedevils seniors and which this bill will exacerbate.
And H.R. 2 will have additional adverse effects on the elderly. Having made it more difficult for seniors to see a doctor, the bill will add more to the out-of-pocket cash they must pay when they finally get an appointment. Many seniors use so-called Medigap plans to cover deductible and co-pay amounts remaining after Medicare pays. This bill will restrict the ability of new enrollees to use such policies “by prohibiting plans from covering the Part B deductible.” This has been brushed off by most of the bill’s supporters as small change, but it will not be seen as such by low income seniors.
Since H.R. 2 passed, John Boehner has received praise from the President, congratulations from congressional Democrats, and accolades from the legacy media. This should worry him. These people are not his friends. Yet he has his staff posting their disingenuous bilge on the Speaker’s website. He’s evidently so pathetically grateful not to be trashed by them that he is willing to toss fiscal husbandry to the wind, render the health care system even more dysfunctional than Obamacare has already made it, and make life more difficult for seniors. We can only hope that Mitch McConnell isn’t so easy.