President Obama made it clear during his we-need-to-tighten-our-collective-belts speech on Wednesday that he intends to ask for $480 billion cut from Medicare and Medicaid by 2023 with an approach that is sure to hamstring doctors and frustrate patients by extending government control and restrictions (aka rationing).
According to the president's proposal, the Independent Medicare Advisory Board, which will be formed in 2018, will play an expanded roll in determining what are -- or are not -- essential medical procedures and treatments.
If President Obama has his way, the federal government will also decrease its spending on prescription drugs, increasing negotiating leverage and the use of generics to lower costs (a process critics aptly call “forced substitution”) while supposedly clamping down on rampant fraud and abuse.
Anyone who's been following the president's rhetoric on health care entitlements during the past two long years did not expect him to suddenly change course in his speech on Wednesday and support Rep. Paul Ryan’s plan to privatize Medicare beginning in 2021.
But Ryan's ideas are far from pie-in-the-sky. In his budget proposal Ryan expressed concern about some of the same ObamaCare provisions that deeply worry me and other doctors.
The IPAB is only one of many government committees which are forming to decide for Medicare (and the private insurances that will follow suit) exactly which treatments are beneficial or cost effective and which aren’t. Do you trust your government to decide which procedures and medications and tests should be covered and which shouldn’t?
This determination will make the practice of medicine even more difficult, especially when you consider that the elderly as a group have more medical problems, need more diagnostic tests, and require more treatments. Most of us who take care of these patients at a fraction of what we used to receive for a visit are worried that with all these growing restrictions, committees, and denials, we will soon spend our entire day documenting and appealing until we can no longer afford to continue seeing Medicare patients at all.
But it seems that ObamaCare has considered this eventuality too. The new law will also be rolling out something called "Accountable Care Organizations" which will destroy private practice even as it rewards so-called "quality outcomes."
Consider that quality under ObamaCare is just another euphemism for streamlining treatments and services. Only large groups and hospitals will be able to stay in business, hiring efficiency experts to preserve their bottom line. Very sick patients with multiple problems may receive mandatory coverage under the new law, but the ACOs will be wary of sick and dying patients who interfere with their bonuses for keeping people well.
Regulating Medicare as Obama envisions it may be a way to try to save money, but it is also sure to make Medicare is much more unwieldy. Attempts to cut fraud and abuse that are built into the law will be largely ineffective without including incentives for practitioners to police themselves.
I believe that medical panels comprised of doctors should be formed to police physicians in our profession. Otherwise medical criminals will find ways around the new restrictions just as they found ways around the old ones. Doctors who order unnecessary tests and treatments for profits will continue to find ways to do so.
Without tort reform (glaringly left out by the lawyers who gave us ObamaCare), we doctors will continue to practice defensively, a culture that leads to ever spiraling costs.
Rep. Paul Ryan has a different idea, though for me and many other doctors, his plan to give seniors a lump sum to spend on private insurance is not a cure-all either. Private insurers restrict us too, and even if these denials are easier to appeal then with government-run insurance, they also become more difficult as patients age and get sicker.
I believe that raising the retirement age is a much more practical and realistic first step to save Medicare money. Today’s 70 is yesterday’s 65. Since patients are living longer (over 70 million baby boomers will enter the Medicare ranks over the next several years) and remaining in better health, it also makes sense that even as people work longer they can also wait longer to be added to the ranks of the entitled.
I am all for privatizing Medicare up to a certain age, perhaps 75, while beyond 75, when age-related illnesses really take hold, it makes sense to find ways to limit the overuse problem without cutting down on essential services.
Medicare (and Medicaid) definitely need to be drastically cut before these programs go belly up. But these cuts must take place without violating the physician’s Hippocratic Oath to first do no harm.
Marc Siegel M.D. is a professor of medicine and Medical Director of Doctor Radio at NYU Langone Medical Center. He is a Fox News Medical contributor and the author of the new book "The Inner Pulse: Unlocking the Secret Code of Sickness and Health."