Joe Scarborough reminds us that the divisions in American government are hardly new, paraphrasing Benjamin Franklin’s observation that “When you assemble a number of men, to have the advantage of their joint wisdom, you inevitably assemble . . . all their prejudices, their passions, their errors of opinion, their local interests, and their selfish views. From such an assembly can a perfect production be expected?” (This comes from a September 17, 1787 speech by Mr. Franklin to urge ratification of the U.S. Constitution, read on his behalf because he was too ill to deliver it in person. The Constitution was ratified the same day.)
I suppose we should be encouraged that Congress’s prejudices, passions, errors of opinion, local interests and selfish views are as American as apple pie, and the Republic has somehow survived nonetheless. Still, I find it deeply troubling that today’s politicians can’t find their way to agree on the debt ceiling.
No one should expect a “perfect production” to come out of this Congress and this administration, given how far apart they are on the need for tax increases and entitlement reforms. But they need to agree to something, and they need to do it soon.
I will leave it to others, who know a lot more about global economics than me, to explain what likely will happen to the economy if the debt ceiling isn’t increased by August 2. Let’s talk about the impact on health care, something I know quite a bit about—and why physicians especially should be concerned:
For one thing, as I blogged last week, physicians will be hit squarely in their pocketbooks if the debt ceiling is not increased by August 2. The government will experience a massive and growing cash flow shortage; and as a result, “handling all payments for important and popular programs (e.g., Social Security, Medicare, Medicaid, Defense, active duty pay) will quickly become impossible.”
Without enough cash on hand, the federal government will be forced to prioritize its payment obligations. Is there any doubt that if the choice is between suspending Social Security checks to seniors or Medicare payments to doctors, doctors will the first ones to be shorted?
Physicians should be very, very concerned that weeks could go by in August before they would get even one dime from the federal government for their services to patients. The same is true of hospitals, who may not receive any payments for treating Medicare patients or for paying residents’ salaries.
Failure to reach agreement on the debt ceiling also would result in more than half of the 1.9 million government civilian employees losing their jobs overnight, according for former GOP Senate budget committee staffer Steve Bell. Included will be federal employees who work for the CDC, NIH, FDA, CMS, and the other regulatory agencies that physicians and patients alike count on to keep our food and drugs safe, the protect us from communicable diseases, conduct medical research and administer Medicare and Medicaid.
Let’s say that the politicians do find a way to authorize an increase in the debt ceiling in time to avert massive lay-offs and an immediate suspension of payments to physicians. Physicians should be paying very close attention to how Medicare, Medicaid and other critical health programs may be affected. President Obama has put on the table major structural changes in Medicare, including gradually advancing the age of eligibility to coincide with Social Security—but only in the context of a $4 trillion “grand bargain” on deficit reduction that includes tax revenues, which the GOP has rejected.
The GOP has countered with a smaller deficit reduction package that over ten years would cut Medicare by $250 billion. Included in the GOP proposal, which was rejected by the president, is a $14 billion cut Medicare GME/IME funding, $1.1 billion in savings from requiring prior authorization for high-cost imaging, another $0.8 billion by cutting payments for imaging, $8.5 to 16 billion by charging co-pays for laboratory services, and $38 billion by requiring higher income beneficiaries to pay more into the program. None of the proposals being offered so far by either party appear to include permanent repeal of the Medicare Sustainable Growth Rate formula, a top priority of organized medicine.
Given the high stakes, it has been especially surprising to me that more physicians aren’t speaking up. To recap: if a deal is not reached, they and their patient will bear the brunt of suspended payments. They and their patients will suffer the consequences of massive lay-offs in the agencies charged with protecting public health. If, on the other hand, a deal is reached, the changes it may make in Medicare, Medicaid and other entitlement and discretionary health programs will have a lasting impact on American health care, potentially for generations to come.
Physicians shouldn’t count on politicians, with “all their prejudices, their passions, their errors of opinion, their local interests, and their selfish views”, to come to a responsible debt agreement, never mind a perfect production. They need to enter the debate and join with ACP to urge agreement on a debt ceiling package that lowers the rate of growth in Medicare and Medicaid spending by addressing key cost-drivers, that permanently repeals the SGR, and that preserves funding for essential programs, in time to avert an unprecedented disruption in payments and mass lay-offs of federal employees that are responsible for ensuring public health and safety.
Today’s question: Why do you think physicians have not been more engaged in pressing Congress and the President to reach a debt deal that averts any suspension of payments, responsibly reduces Medicare and Medicaid spending growth, eliminates the SGR, and ensures sufficient funding for critical programs?