Lawmakers with no thought for future are behind Medicare crisis

Regarding "Time running out to fix Medicare pay" (Editorial, Sept. 11): There are so many levels of problems in the current system that it is truly impossible to separate one from the other. Indeed this is a crisis, but as history has shown countless times, the powers that be are unwilling to make changes until the situation is irrevocably broken. Then the cry is heard, "How could this have happened, why didn't anyone warn us?" One should hope that candidates for office would have a reasonable amount of intelligence and foresight, and the fortitude to use both.

One major obstacle, however, is that politicians continue to promise more than what the taxpayer can deliver in order to get elected -- the short-term problem doesn't matter as long as you get re-elected. The American people have a long track record of electing these types of legislators rather than those who truly have the ability to see future consequences of current actions. More is promised (such as Medicare D) without a thought as to how it will be paid for, and so, as with much of the federal debt, it is put off for someone else (the next generation) to deal with, or through an ever-increasing load of patients (and paperwork) while fees are reduced proportionately.

It is only physicians who shoulder the burden; the insurers, PBMs, device makers, pharma companies are almost guaranteed handsome profits and bonuses.

The reality is that it won't break down any time soon, perhaps not even in most of our professional lives. The majority of us will accept less for our services out of loyalty to our professional oaths, patients, their families and the members of our communities. And we will see more patients to compensate. With that there will be less time to ensure understanding and compliance, and then more claims of malpractice with more verdicts against physicians. The argument will be that all we cared about is seeing as many patients as possible to make as much money as we can.

The greater consequence to this is that commercial insurers continue to base fees on Medicare payments. Here in New Jersey, commercial payments are often less than current Medicare. Dropping Medicare can be the death knell for an office-based practice.

When will it change? Only when enough physicians individually (remember -- no collusion allowed) say "stop" and back it up.

Thomas A. Shaffey, MD, Branchburg, N.J.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2006/10/02/edlt1002.htm.