Monday, August 14, 2006

Bush to Screw Seniors via Medicare Cuts?

How will the 5.1% cut in physician payments play out in my hometown? As most primary care physicians don't accept new Medicare patients, the door to newly covered beneficiaries may slam shut. How many physicians unhappy about the cut will restrict the Medicare portion of their practice? Will they drop any current patients as a result?

President Bush highlighted numerous times, demand for medical care exceeds supply, even instituting a number of programs to reduce demand. His signature strategy is shifting the cost to the patient via high deductible health plans. While these plans are growing dramatically, the number of covered lives in 2005 was estimated at 1 to 2 million people.

In contrast the Medicare cuts are likely to quickly reduce physician supply for nearly 42 million beneficiaries. This will free up physician time to serve patients with better paying insurance status. It won't go to caring for the uninsured, unless their ER call burden grows.

The Bush plan also imposes quality standards. Early identification of health problems is critical to preventing more serious problems down the line. How will the 5.1% cut impact newly covered seniors ability to see their doctor in a timely fashion, if at all? How will those already in a practice be impacted by physicians managing their Medicare load for optimal reimbursement?

What about the people covered? Nearly 9 in 10 Medicare beneficiaries have one or more chronic disease. Most beneficiaries live on modest incomes and rely heavily on Social Security. When the Bush team starts cutting it’s these people who suffer, not the physicians.

While I am not a fan of huge physician incomes, I would much prefer the rich pay a greater share of the care for those unable to pay. Cutting taxes for the wealthy to cut benefits for the poor, elderly and disabled seems mean spirited. This will be sold as a drop in payments to already well off physicians but my guess is the people will pay the price.

I would go on about the Bush quality initiatives, but the American people clearly have seen this administration’s inability to perform competently. What it will do is create a brand new health care information industry, proliferated by for profit companies? Think of the government contractors in New Orleans post Katrina or the CPA’s contracting for rebuilding Iraq. That’s what the Bush team has for America to improve health care, a big government money funnel to Bush’s insider friends. The Carlyle Group purchased MultiPlan just months ago to have a repository for the ka-ching!

To improve quality one must understand and apply Dr. Deming's System of Profound Knowledge. Simply contracting out the job requires no knowledge of systems, variation, psychology, knowledge and their interactions. However, it gives the appearance of purposeful activity while accomplishing little. It could even make things worse.

Dr. Deming said "We are being ruined by best efforts." The Bush team certainly seems to qualify.

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