"We're Number One!"

... some health policy ranting for the weekend.

Courtesy of Kaiser Health News, here's a brief summary of the Medicare "doc fix":

The Fiscal Times: Is There a Doctor Fix in the House….And Senate?
Last June, the Congressional Budget Office calculated it would (cost) $275 billion to maintain (Medicare) physician pay at current levels over the next ten years. ... it's likely that this year's fix - like last year's fix - will be a one- or two-year stopgap measure that uses ten years of savings from some minor limits on spending in other parts of the Medicare program. That’s right. Congress votes and the president signs a bill that counts ten years of savings to pay for one or two years of spending (Goozner, 11/23).

Yes, it really is as stupid as it sounds. This particular mess dates back to the 1990s when Congress had the, on-the-face-of-it sensible, idea that total Medicare payments to doctors should grow no faster than the rest of the economy. However there were two problems with that: one, aggregate (and doctor-specific) medical costs have grown faster than general inflation for years, both before and after this particular balanced budget amendment, and two, the tool for controlling these costs was to limit prices paid to doctors without limiting the number of services performed for Medicare beneficiaries (and three, it lumps some very disparate things from primary care visits to drug infusion therapy under the umbrella of "physician services" some of these categories of costs have grown much faster than others).

Then of course when they don't like the results of their own cost-control formula, Congress passes a fix that delays the pay cut to doctors for a year (which they've been doing for the last ten years) but doesn't abolish the formula because as long as it still exists and, under current law, "really will take effect next year" then they don't have to find money to pay for the billions it will cost to abolish the spending cap formula over the next decade. And they do the same thing the next year. And furthermore it is cumulative so what was a 10% difference in payments 5 years ago is now a 27% projected cut...next year it will be more than 30%.

Also a new report from the OECD shows that the US is still number one in health spending. We spent $7,960 per person on health care in 2009, compared to the average of $3,233. For that price...our 5-year breast cancer survival rates are the best in the world but our rates of hospital admissions for uncontrolled asthma are 2.4 times higher than the OECD average, our life expectancy at birth is lower. You do well in the US if you have cancer, less well if you have chronic disease or need primary care. More here on the KHN blog.