I saw my doctor Saturday, not in the examining room but on the op-ed page of the Washington Post. Dr. Michael A. Newman is one of the most dedicated public servants I know. When we think of the phrase "public servant" we conjure up an image of a politician trying to find a word that poll-tests better than "politician" to describe himself. But, doctors, too, are public servants in a broader sense.
Newman was writing to urge Congress to bite the bullet and fix the Medicare reimbursement rates which currently are so low, they are driving doctors to decline to take Medicare patients. "Now is not the time for Congress to be penny-wise and pound-foolish," Newman writes, an admonition I delivered last week regarding stimulus spending. Stimulus spending is different from a permanent "doc fix." The latter will have an impact on the budget for the long haul, while Stimulus is, by design, a one-time expenditure of funds to prime the pump. But, they share a different, non-fiscal similarity: the American people need to have confidence in the management of the economy and our seniors need to have confidence that there will be doctors available to care for them. If this is not an example of how to "promote the general Welfare and secure the Blessings of Liberty," I am not sure what is.
In his article, Dr. Newman notes that specialists are often paid considerably higher than general practitioners, which is something that bears analysis and modification. I am sure that this difference is market-driven, but I am also sure that there are ways to set parameters around the market. In fact, we do that all the time for teachers, whose school budgets must be approved by voters, for other employees of the government, and, most especially, for members of the Armed Forces. Those who think the market solves everything and denounce government interference should ask themselves why we make national defense a monopoly, controlled entirely by the government? The reason: There are public purposes that we, as a people, believe should not be subjected to the vagaries of market conditions. I would have preferred a health care reform bill that went further in this direction, but I know that no such bill could pass.
What Newman points out, however, is that the health care reform will not work if the current system is made to absorb 30 million new patients and, because of pay scales, the number of primary care physicians does not grow, or the primary physicians we do have get out of the business of caring for the elderly. Certainly, those 30 million new customers represent a powerful bit of leverage for the government. We could, for example, stipulate that no specialist, such as a cardiologist, can be reimbursed through a health care policy purchased on the new exchanges unless ten percent of their caseload is made up of Medicare and Medicaid patients. Or twenty percent. I will leave the numbers to Mr. Orzag.
The key is that we have a fundamental responsibility as a society to make sure that we have made provision for health care for our elderly, indeed for all. Health care is a basic human right as the Church has taught consistently in all of her statements on the issue. That responsibility to care for the aged and the inform cannot be shirked. The health care reform bill was a major step towards fulfilling that responsibility, but addressing this complicated issue of Medicare reimbursement is critical as well. I do not detect in the Congress or in the White House much in the way of pre-election courage for any policy proposals that do not create jobs. But, if not action can be taken earlier, the day after the election, the Congress should take steps to fix this problem and to do so permanently. Our older citizens deserve not only good health care, they deserve peace of mind that such health care will be there. And doctors like Dr. Newman should not be forced into early retirement because Congress has been spooked into being pound-foolish.
Michael Sean Winters