By the time you read this the physician reimbursement crisis
may have been averted, yet again. But if not, doctors who still treat Medicare and
Medicaid patients will see a reduction of 21.2 percent for Medicare patients
and as much as 42.8 percent for Medicaid patients for services rendered on or
before March 31, unless Congress enacts another “doc fix” before April 1
If the “doc fix” hasn’t yet been approved and isn’t approved
today, both Medicare and Medicaid patients may have a far more difficult time
getting medical care. And if it is fixed this time, what will happen when this
fix expires?
This is yet another of the blessings of Obamacare, the
Patient Protection and Affordable Care Act, enacted in 2010, and through
tortured legal reasoning was ruled constitutional by the U.S. Supreme Court.
Obamacare is not the first government action to reduce
reimbursements for Medicare and Medicaid patients, but because Obamacare put
millions more people in the Medicaid system in order to increase the number of
Americans who could then be counted as “insured,” it gets credit for the
current crisis. And to keep down vocal physician opposition to adding millions
more to an already broken system, Congressional Democrats who created Obamacare
included a two-year increase in reimbursement rates that are now set to expire
April 1, and that means the lower reimbursement rates will be back, if the “doc
fix” isn’t passed.
Doctors generally get paid less for Medicaid and Medicare
patients than their cost basis in treating them, and situations like this one
magnify that problem. Consequently, some doctors limit the number of Medicaid
and Medicare patients they see, and some do not treat them at all. Don’t be
surprised if this situation causes more doctors to join those ranks every year
until reimbursements for services to these patients are stabilized at a higher level
so that doctors don’t lose money treating them.
On one hand we should support efforts to reign in absurdly
high levels of government spending, which in 2014 was approximately 17 percent
higher than revenue, meaning that for every dollar of tax revenue there’s 17
cents of deficit spending that the government has to borrow. But on the other
hand, shortchanging physicians who treat America’s elderly and low-income or
welfare-supported citizens is a foolish way to do that.
This is especially unfair to Medicare patients, who are not welfare
recipients, and who, of all those who receive government benefits, are truly entitled
to them. They receive essentially their own money, and that of their employers,
both of whom had money taken from them by the government to fund Social
Security, and later Medicare. These benefits are not the same as Medicaid, food
stamps, child support and other welfare money.
The Social Security Act was passed in 1935 and is a promise
government made to American workers and their employers that the money government
took from them would be put in a trust fund and invested, and returned to them
in their later years.
Predictably, the government then used that money for other
purposes, not for the benefit of the people the Social Security Trust Fund
exists to serve. The Trust Fund is now bankrupt, for all practicable purposes,
being in the red approximately $300 billion.
And that raises the question: How is it possible that the
Social Security Trust Fund, which was built by the monetary contributions of
its recipients and their employers, can run out of money, but the “fund” that
pays from $700 billion to $1 trillion annually for welfare in all its numerous
forms, never runs out of money?
The “doc fix” that will help doctors who treat Medicare and
Medicaid patients will also add to the deficit, and that obviously is bad. We
need to spend less money, but we also need to not limit medical care to those
who need it. The solution lies in repairing the Medicaid system, which provides
care to millions, and many are perfectly capable of funding some or all of their
own care. Welfare must be reserved for those who are truly needy and have no
other solution.
And now, from centuries ago, here is a statement addressing
the situation in which our once great nation now finds itself:
"A nation can survive its fools, and even the
ambitious. But it cannot survive treason from within. An enemy at the gates is
less formidable, for he is known and carries his banner openly. But the traitor
moves amongst those within the gate freely, his sly whispers rustling through
all the alleys, heard in the very halls of government itself. For the traitor
appears not a traitor; he speaks in accents familiar to his victims, and he
wears their face and their arguments, he appeals to the baseness that lies deep
in the hearts of all men. He rots the soul of a nation, he works secretly and
unknown in the night to undermine the pillars of the city, he infects the body
politic so that it can no longer resist. A murderer is less to fear. The
traitor is the plague." - Marcus Tullius Cicero (106-43 B.C.)
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