March 26th, 2010
12:01 PM ET

The old pea and shell game

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Tom Foreman | BIO
AC360° Correspondent

One of the truisms of politics and of piles of laundry in a teenager’s room is that no problem is so big it can’t be pushed aside, at least for a while.

Case in point: The growing issue of Medicare payments to doctors. I know it sounds boring, but stick with me … like Betty White’s career, it gets better as it goes.

President Obama and Democratic members of Congress made a great fuss in the run up to the health care vote about how the whole matter was deficit neutral at worst, a deficit reducer at best. And the Congressional Budget Office confirmed that they were telling the truth. The trouble is, with the ink barely dry, Dems are already considering another major piece of medical legislation which, had it been included in the original bill, would have turned reform into a budget buster and possibly torpedoed chances for passage.

Here is the tale in a nutshell (or a bedpan, take your pick.) When President Lyndon Johnson signed Medicare into law in 1965 to give care to the elderly, doctors were allowed to pretty much decide what was fair compensation and the government paid it. Then the costs ballooned, debates broke out, and in 1992, the government adopted a formula to govern those payments. And now everything is a mess.

While the cost of tests, procedures, supplies, and doctors’ time has steadily risen, the amount being paid to doctors under the Medicare formula has fallen. At the end of this month, the formula calls for a 21 percent cut in Medicare payments to doctors. You can imagine how thrilled they are. And you can imagine how many may finally throw up their hands and say, “no more Medicare patients for me.”

It’s a puzzle. Fixing the formula and restoring those payments would cost $210 billion. Adding that to the health care bill would have poured red ink all over the Capitol carpets. But leaving it until later looks like a pea and shell game aimed at hiding the true cost of reform.

The House has approved a fix already. But many pol watchers expect it to die in the Senate. Budget hawks there will likely prefer what they’ve done before: a quick payment to the docs to buy some time. In other words, treating the symptoms, not the disease.

Filed under: Opinion • Raw Politics • Tom Foreman
soundoff (2 Responses)
  1. Tim Gibson

    Call it a little bit of grits with that green egg and ham. Now we need a big biscuit to swipe it with right.

    Massive train wreck, film at 11.

    March 26, 2010 at 1:27 pm |
  2. Sue Rowland from Waverly, Iowa

    Unfortunately, for change to take place this is what happens. That's why health care reform failed in the past cuz the real path to change is too expensive so now @ least we're headed in the right direction but we will have to keep patching some things so everyone doesn't go ballistic over the costs & nothing would ever get done.

    March 26, 2010 at 1:18 pm |