When I was growing up, my buddy had a German shepherd he named “Doc.” I have to confess that whenever I hear “Doc Fix” I think of what a veterinarian once did to poor old Doc. Every year since the sustainable growth rate (SGR) was enacted as part of the Balanced Budget Act of 1997, there has been discussion of the “Doc Fix” — the physician payment schedule adjustments meant to achieve SGR.
After President Obama signed the Boehner-Pelosi $200 billion Medicare Reform package, the chief Medicare actuary issued a report that indicated my recollection of “Doc Fix” is closer to the truth than what Congress and the White House would have you believe. Reading analysis of the new law, it is clear that there is more smoke and mirrors in the law than if a carnival funhouse had burned to the ground.
For the last 17 years Congress has postponed (a nice way of saying “delayed the inevitable”) these reductions that, if now taken in aggregate, would reduce payments to physicians by 21 percent. Had that action been taken, doctors warned that they would stop seeing Medicare beneficiaries altogether. Doctors and their Medicare patients besieged Congress to find another solution. This is a long-term problem and requires a long-term solution. Yet no analysis I could find in researching this column supports this legislation as such a solution.
What the law does is shift some of the costs to the very beneficiaries who were pressuring for that alternate solution. There will now be a limited version of the means testing some analysts and legislators have been seeking. Starting in 2018, higher income beneficiaries will pay higher premiums for doctor visits and medicines. A year later, Medigap plans will no longer cover the deductible for doctor visits. While the President hailed the bill as “A significant bipartisan achievement,” it seems more like just another new can being kicked down an old hallway.
John R. Graham, from the National Center for Policy Analysis, says, “There are two major differences between this so-called ‘fix’ and previous ones. The first one is real: Previous increases have been offset by cuts to other government spending, and this one is not. The second one is fiction: that this Doc Fix is a permanent solution to the fee problem.”