It’s starting to get old. But he makes one valid point – reducing physician reimbursement does not necessarily reduce health care costs:
And after about 20 years of seeing the rate of health care costs increase dramatically the government and private payers have looked for ways to slow their health care costs. The government tends to lead the charge on this because the government pays for Medicare which is by far the biggest and most important health care program in the U.S. Inevitably reducing physician fees is a prime candidate. Reducing the fees is only half the equation, however. Physicians also tend to get paid for each service they deliver. So typically any attempt to reduce fees results in physicians increasing services – not only those they provide themselves but also the attendant tests, hospital admissions and other things that go along with that. So a cut in fees doesn’t convert to a straight cut in income, or a reduction in health care costs overall.
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Is this surprising? A growing population of eligible elderly beneficiaries who are living longer are going to each consume more services, even if they don’t consume services more frequently.
If Medicare wants to cut total expenditure, they will simply have to cut out eligible services, either by CPT code, which would be simple but unpopular, or by total annual or lifetime expenditure, which would be more complicated and equally unpopular.
Cutting per-procedure reimbursement is the cowardly way out; inevitably it leads to providers dropping Medicare as an accepted plan, which will occur in a haphazard way, as each participating practice will have to evaluate its ability to provide at the obtaining rates. This will disfavor practices in high cost areas and those who have additional burdens of accepting a large census of patients with even worse coverage, like Medicaid. It will hurt the practices who serve the most vulnerable patients.
Okulus
Post hoc ergo propter hoc. Or maybe not.
The AMA lobbies in the interests of its members, and promotes its position as also being in the interests of patients.
Patients consume health care services. As there are more and more of them, there is overall more consumption, and more expenditure, despite per-service cuts under Medicare’s computation formulae. No surprise. People want what is available, and want it even more freely when they don’t have to pay for it directly themselves.
So is it logical to assume the AMA is driving this? Or it that merely coincidence? Are there other larger forces in the medical care economy that figure far more importantly in the overall costs to the Medicare program?
Blaming the AMA is just plain foolish and stupid.
Why not skip paying physicians altogether? This would eliminate all costs and free up more money for the war in Iraq.
Disclaimer: I am not an AMA member.
I have become automatically dismissive of anyone who dances out the paper dragon of the AMA and pretends that it is some sort of master manipulator of the political process in the absence of which there would somehow be a shiny, better and more affordable medical future for every living American. I believe that no more than I would the claim that if the NEA didn’t exist, we’d all become smarter and better-educated. It is just laughably preposterous.
As long as professional, business and any other special interest organizations are allowed to include political activity among their organization’s missions, then the AMA should be entitled to represent its members as it does. It should be entitled to make recommendations, solicit opportunities to comment on matters of medical education and offer or withhold its endorsements as it chooses. If governments want to defer to them, fine. If not, fine, too. If the AMA thinks that acupuncturists or Rolfers or whomever are not in its opinion qualified to practice medicine and surgery, they ought to be able to petetion the government to those ends. If the AMA does not want a health market free-for-all, it ought to be able to lobby against that, too.
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