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The breathtaking crisis in the financial markets has put this country’s healthcare crisis on the back burner. The price we are now being asked to pay for, having allowed the underlying problems to fester, is shocking. Like all recent bubbles (the dotcom bubble, the housing bubble, etc.) the path to the bottom should have been clear long before the bubble burst and the crisis exploded. That is why it is important to all of us, seniors in particular, to understand the precarious status of Medicare; the next bubble waiting to burst.
Medicare is a complex system with numerous structural problems that endanger its long-term existence. A core issue, however, is whether seniors will have access to physicians. Access relates directly to physician reimbursement under Medicare. This summer, physicians faced an automatic across the board 10.6% cut in Medicare reimbursement under the Medicare Sustainable Growth Rate (SGR) formula. These cuts have a domino effect as most payors peg their payments to physicians on the Medicare rate. The Medicare Improvement for Patients and Providers Act of 2008 (HR 6331) was introduced to reverse these cuts. Opposition to the act centered primarily on efforts to protect highly profitable private Medicare plans at the expense of seniors and their physicians.
Senator Barack Obama voted in favor of the act, joining all Democrats and nine Republicans in support of seniors and their physicians. Senator John McCain voted absent and thus HR 6331 fell one vote short. The 10.6% cuts took effect on July 1. Although the act passed in the House, Arizona’s entire Repulican congressional delegation (Reps. Shadegg, Renzi, Franks and Flake) voted against the bill, while the Democratic delegation (Reps. Giffords, Grijalva, Pastor and Mitchell) stood on the side of seniors and their physicians. The act was reintroduced a week later and this time passed by a veto-proof majority. Senator Edward Kennedy, who was still recuperating from brain surgery, made the trip to Washington to cast his vote. Senator McCain again voted absent. President Bush vetoed the bill and Congress overrode the veto – preserving physician payments, at least for 18 months until the next round of SGR cuts. Again, Senator McCain voted absent, refusing to make at least a symbolic gesture in support of seniors and their physicians.
Why should all this matter to average citizens, particularly seniors? After all, physicians remain well reimbursed, right? The simple answer is that cuts in Medicare physician reimbursement threaten seniors’ access to physicians. An increasing number of physicians are opting out of Medicare and some subspecialties, such as my specialty of heart surgery, are in crisis as a result of these cuts. Medicare today pays heart surgeons about 50% less for a bypass operation than it did 20 years ago (70% less if adjusted for inflation). This has transformed our specialty from a rigorous but highly competetive specialty that attracted the best and brightest to one that medical students are avoiding like the plague. The number of applicants has declined over 50% in a decade. Nearly half of all training slots are unfilled or filled by foreign medical graduates. It is estimated that 70% of heart surgeons currently in practice will retire in 13 years. Seniors needing life saving heart surgery will soon face a shortage of qualified surgeons.
This is of course one narrow but dramatic example of the pending crisis in Medicare. When this bubble bursts, the crisis will not only involve huge sums of money or the survival financial institutions, it will involve the lives of actual patients.
This upcoming election provides stark choices at the presidential and congressional level with regard to support for Medicare. Everyone, particularly seniors and their physicians, need to pay very careful attention to the events of this summer to understand which candidates are committed to supporting Medicare and the seniors who depend on it.
Dr. Lishan Aklog, Chair, The Cardiovascular Center; Chief, Cardiovascular Surgery, St. Joseph’s Hospital and Medical Center in Phoenix