Wednesday, June 23, 2010
Playing chicken with health care
This post by Rob Lamberts, ACP Member, appeared at Musings of a Distractible Mind.
Chicken-- noun - A game in which the first person to lose nerve and withdraw from a dangerous situation is the loser.
This definition is wrong. As of June 18, 2010, the definition is as follows: Chicken--noun - A game in which members of Congress put Americans in a dangerous situation, with the healthcare system being the loser.
In my lament about losing my Medicare population if the 21% cut went through, Maggie Mahar commented on my post: "Please don't worry about the 21% cut. This is something that the AMA and conservatives use to fear-monger--it will never happen. It is a very crude solution to health care costs--even our Congressmen understand this. That is why they never implement it.
"On the other hand, moderates are afraid of upsetting conservative voters by killing it. So they just keep postponing it. And then conservatives use the fear of it to advance their agenda with doctors. But it won't happen."
Well, the government is, at this moment, cutting checks for service I rendered earlier this month that are 21% smaller than in the past. Despite the fact that the Senate passed a bill not only putting off the 21% cut, but actually raising the pay of doctors, the House is not happy with it.
"WASHINGTON--The top House Democrat says her chamber won't vote on Senate legislation to reverse a cut in Medicare payments to doctors.
House Speaker Nancy Pelosi says the bill--it would reverse a 21% cut on Medicare doctor fees that was imposed on Friday--has to include elements of the Democrats' jobs agenda.
The move by the California Democrat appears aimed at pressuring the Senate to break a logjam on long-sought legislation to extend unemployment benefits and give money to states to help them avoid additional layoffs and furloughs. That bill is stuck on the Senate floor because of a GOP filibuster.
The Senate passed the doctor fee fix as a stand-alone measure on Friday after a GOP filibuster killed the bigger jobs-related measure the night before. The measure would only forestall the cuts--they are required under a 1990s budget-cutting law that Congress has routinely waived--for six months. (Associated Press)"
So as of now, I am being paid 79% of the already low Medicare reimbursement. I hope Maggie Mahar is right about this being simple political posturing, but pardon me if my trust of politicians acting rationally is a bit weak. It's a great big game of chicken. The House is playing chicken with the Senate. The Democrats are playing chicken with the Republicans. They aren't in the cars themselves, we are. Doctors and patients are careening toward destruction in the name of political gamesmanship. Surely they will flinch. Surely someone will understand the consequences of the crash. But you know what? Sometimes each side expects the others will be the ones who flinch. Sometimes nobody flinches. Sometimes the cars crash and people are killed.
The longer the 21% cut is allowed to exist, the less shocking it will seem. The checks are being cut, and the world hasn't ended yet, right? Patients are still getting care. Doctors are still earning an income. People will adjust.
The only thing that is preventing absolute chaos in the system is the fact that nobody thinks politicians could really be this stupid. But is that really true? Who will take the political fallout if the 21% cut stands? The Democrats in the house for not passing the Senate bill? The Senate Republicans who are filibustering the bill the House would accept? Each side can demonize the other, and each side is insulated by that fact. Maybe the politicians see the implosion of the system as an opportunity to bury their opposition in the fallout.
But we are in the cars, people. We are the "casualties" that they will posture about: doctors who lose income, patients who lose doctors. It will happen. The longer the 21% cut is in place, the more solid this insanity seems, the more physicians, especially primary care doctors, will simply close their doors to Medicare patients. We can't "get used to" losing money by seeing people. It is already happening, and it will gain momentum as this madness continues.
Medicare is fragile, and this cut is a sledgehammer. It's not evil Democrats. It's not stupid Republicans. Conservatives and Liberals are both acting irresponsible. They're all betraying the trust we gave them.
Trusting Congress is more and more feeling like being asked to trust an abusive spouse. We want to think the best of these people who claimed they meant to take care of us. We want to think that they understand what damage they are doing. But sometimes insanity grips people and they stop looking at any needs but their own. They betray their vows.
Even if this disaster is averted, staying in Medicare feels more and more like we are enabling the pathological behavior of our "representatives." If they don't pay the political price for destroying health care for their own political gain, we all lose. The gamesmanship will continue and the stakes will get higher. I am just getting tired of being a pawn in the game. Averting this disaster will only embolden congress to go further in this game of chicken.
If things don't really change, the cars will really crash. That's when we all feel the sudden shock when our car meets the other at 100 miles per hour.
Then there is just wreckage.
It's not a game.
People will die.
Rob Lamberts, ACP Member, writes the blog Musings of a Distractible Mind and is on Twitter. His podcast, House Call Doctor, is available online and on iTunes). He is board certified in Internal Medicine and Pediatrics and was an early adopter of electronic medical records.
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