GOP doctors stand behind Medicare privatization plan

Washington -- Republican physician members of Congress will continue to support a House-approved plan to transform Medicare from a fee-for-service program to a voucher program, members of the GOP Doctors Caucus said.

Republican doctors in the House and Senate held a June 22 briefing to rebut claims by the Obama administration and congressional Democrats that the GOP's long-term reform plan would "end Medicare as we know it." The slogan has proved to be an effective campaign tool against vulnerable Republicans, with numerous observers concluding that the assertion helped persuade a traditionally GOP district in upstate New York to elect a Democrat during a special House election in May.

Caucus members told reporters during the briefing that the Republican plan would save the Medicare program from becoming insolvent and allow patients to choose coverage that is best for them. The caucus came out strongly against Democratic alternatives to reform Medicare. For instance, President Obama has proposed to control costs largely by strengthening the Medicare Independent Payment Advisory Board authorized by the national health system reform law.

The IPAB's 15 members would recommend cuts when spending exceeds growth targets starting in 2014. Obama wants to lower the initial targets established by the reform law, a move that would increase the likelihood that the board would need to recommend deep cuts.

"As physicians, we understand that a good diagnosis is an honest one, and are choosing today to put our former patients' well-being ahead of any political popularity or expediency," said Rep. Phil Gingrey, MD (R, Ga.), co-chair of the caucus. "That's why we are here today to inform patients, families, seniors and all Americans about the realities of the Obama administration's plan for Medicare -- that is, slash the program today and slash it tomorrow."

Rep. Tim Murphy (R, Pa.), a psychologist and the caucus's other co-chair, said the Republican plan has been misrepresented. American seniors already have some choice of private plans through Medicare Advantage and Part D drug plans, and long-term reforms outlined by House Budget Committee Chair Paul Ryan (R, Wis.) would maintain that choice, Murphy said. Ryan's Medicare proposal would not apply to anyone who is now 55 or older.

Sen. Tom Coburn, MD (R, Okla.), said the IPAB and other policy changes in the health reform law spell disaster for seniors. If the nation has a shortage of primary care physicians now, a board with the authority to cut pay for physicians and others would mean patients losing access, he said.

Today's Medicare must change given the nation's financial situation, Dr. Coburn said. He insisted the program is on an unsustainable path, with expenditures projected to grow to 5.2% of gross domestic product in 2030, up from 3.6% in 2010.

"Do you want to be in control of your health care, or do you want a bureaucrat in Washington to be in control of your health care?" Dr. Coburn asked.

Rep. Jim McDermott, MD (D, Wash.), a psychiatrist and the only Democratic physician in Congress, said the IPAB is not the best way to control Medicare costs, but he does not favor the Republican approach, either. He supports collective negotiations between physicians and payers -- including government programs, private employers and individuals -- to rein in spending.

The Republican alternative is unworkable, Dr. McDermott said. The Medicare program was created because the private sector could not provide affordable insurance coverage to the elderly. He said the program has provided reliable coverage to millions of seniors at a relatively affordable cost.

"Seniors want certainty, and the Republicans are taking away certainty," he said.

Health and Human Services Secretary Kathleen Sebelius defended the IPAB in a June 23 opinion article first published by the Washington news outfit Politico. The health system reform law explicitly prohibits the board from making recommendations that ration care or negatively affect patient benefits.

"These restrictions are clearly spelled out in the law," Sebelius said. "The claims that the board will ration care are simply false."

IPAB repeal effort continues

The American Medical Association and other physician organizations oppose the scope and authority of the IPAB, and they have advocated for major changes to the board. The board would create an arbitrary system to control costs on top of the sustainable growth rate formula that already has physicians lined up for deep pay cuts, the AMA has said.

More than 250 members of organized medicine and other health care industry groups drafted a June 24 letter urging Congress to repeal the IPAB. The groups -- including the American Academy of Neurology, the American Assn. of Orthopaedic Surgeons and the American College of Emergency Physicians -- say cost control recommendations drafted by the IPAB would not be the correct process for achieving program savings.

"Abdicating this responsibility to an unelected and unaccountable board removes our elected officials from the decision-making process for a program that millions of our nation's seniors and disabled individuals rely upon, endangering the important dialogue that takes place between elected officials and their constituents," the letter states.

Rep. Phil Roe, MD (R, Tenn.), has introduced a bill to repeal the IPAB. The Medicare Decisions Accountability Act of 2011 had 144 co-sponsors as of this article's deadline.