Monday, August 09, 2010

Will health care law make Medicare more fiscally viable by making care less available?

Two recently released projections of what Obama Care (PPACA aka ACA) will do paint different pictures.
The paper by the Medicare Trustees take the provisions as written,assume that the provisions will be met and conclude that Medicare will remain fiscally viable for a longer period time than would obtain that if the bill were not passed.

The Chief Medicare actuary, however,claims that it is highly improbable that the cuts to Medicare providers, that are necessary to make Medicare more solvent, will ever happen. Congress , so far, repeatedly postponed the looming SGR formula cut so that now to belatedly enact them would bring about a 30% cut in Medicare fees for physicians. This would cause an even greater exodus from Medicare on the part of physicians, particularly primary care docs-internists and family physicians, at a time when some 31 millions folks will have recently obtained health insurance and will be seeking primary care.At least some of these will have plans that will pay more than Medicare.Further with the cuts to Medicare Advantage more senior will be looking for primary care docs in the traditional Medicare program.

So, if Congress would re-grow a spine and invoke the cuts to Medicare it may well be the case that Medicare patients will struggle to find primary care and lines will form. If they don't, the allegedly effect of making Medicare more solvent will not occur.In any event lines will form. Shortages are one foreseeable consequence of price controls and University of Chicago Law School professor, Richard Epstein, has characterized the health care bill as a giant mishmash ( my paraphrasing ) of price controls.

If the cuts do occur it is projected (by the Medicare Trustees) that Medicare reimbursements will fall below those of Medicaid by 2019. How many internists will participate in Medicare with that level of reimbursement? How many internists accept Medicaid patients now? The leadership at AMA and ACP should have second thoughts for sponsoring a plan that would so seriously reduce access to care by the Medicare population.See here for John Goodman's comments about Medicare projections.

President Obama in a recent radio address and Paul Krugman in a recent column ( see here) and a spokesman for the American College of Physicians in a recent blog all heralded the projected increased soundness of Medicare.We were not told much if anything specifically about the report of the Medicare's chief actuary regarding the implausibility of the cuts to Medicare actually happening and thereby the savings evaporating.The wink-wink-nudge-nudge dance and the attempts try to find the right shade of pig lipstick continue.

1 comment:

Anonymous said...

How long can Congress play kick-the-can with the SGR mandated cut in Medicare?