Sam Uretsky

Do Something Different

Could we talk about something else? Just for a while? Like, according to The National Enquirer, Jennifer Aniston isn't engaged to Vince Vaughan, no matter what US magazine says. And according to the Weekly World News, Congressman Kenneth Gurwich (only there is no such person) lost his seat on the House Ethics Committee for turning up in a Spongebob costume, only the blog "GOP and the City" says that it was really Patrick Kennedy (D-RI), although he was never censured, and was never on the ethics committee, and has never worn a costume to Congress -- oh, but we're talking politics again.

Politics is so predictable. At least it has been since the Republicans took over. If, just once, they did something strange, like helping poor people or making it easier for African-Americans to vote, or did something out of character like enforcing laws to protect endangered species, it wouldn't be such a yawn. With them, it's just same old, same old. Been there, done that. The people who gave us the no-bid contract and tax cuts for the rich are socking it to the middle class. No, it's not that their shift from squeezing the poor means that they're become the Party of Ideas, but even they can't get any more blood from their original turnip. The GOP has been reduced to putting the squeeze on physicians, who are generally upper-middle class if there's enough of a middle class left to see the gradations.

On August 8, Dr. Mark B. McClellan, administrator of the Centers for Medicare and Medicaid Services, announced that for 2007, Medicare would cut reimbursement rates to physicians by about 5%, while increasing premiums paid by Medicare recipients by about 11%.

Dr. McClellan said that this reduction in payments would save $13 billion over the next 5 years, and had already been factored into the budget. That's enough to pay for about 43 days of the undeclared War in Iraq. This administration doesn't get the idea. Yes, the cost of entitlement programs like Medicare and Social Security is increasing. They're supposed to. We want them to.

One of the economic truths of health care is that the better the care, the more it should cost. That's distinct from the current economic truth that the more inefficient the system, the more it already costs -- but in an ideal situation, an effective system has to cost more than an ineffective one, simply because people live longer. Nobody has found a way to eliminate healthcare expenses, just to postpone them. In the meantime, all those octogenarians and nonagenarians are going to need checkups and tests, and very likely some medications for the extra 10 or 20 years that they live, and then they'll have the major disease that they might have had a decade or two before.

But Bush et al., who created Medicare Part D, which pays both homage and cash to the insurance companies and pharmaceutical companies, which refuse to let Medicare ask the pharmaceutical manufacturers for better prices, has no hesitation about a unilateral cut in the amount that it pays local MDs. These are nice people, working for a living, trying to pay off student loans -- and while they usually make a respectable income, they don't get stock options or company jets. They're better off than most of us, but not nearly well enough off to get special tax cuts or other goodies.

Anyway, the rate cut isn't likely to help much. There's the Law of Unintended Consequences. You don't have to be a rocket scientist to be a brain surgeon, and it doesn't take much for an MD to balance the budget. Just say "come back in three months" instead of "come back in six months." Some physicians may simply decline to accept Medicare patients, while others will realize that there's an extra test that might be useful. However you look at it, the cuts in reimbursement rates won't simply translate into dollars saved.

The healthcare system in the US is a mess -- although, overcoming great odds, the Bush administration has managed to make it worse, and with our luck they'll try to revive healthcare savings accounts after the elections. What the system needs is a complete overhaul, with enough public and political support to override the pressures of the insurance companies, pharmaceutical manufacturers, device manufacturers and anybody else with deep pockets and shallow minds. Basically, we need a system that rewards good care and doesn't give bonuses for gamesmanship. With an aging population that would like to keep on aging, we need a system that offers more direct care and less administrative expenses. Maybe even increase payments to MDs and RNs and cut back payments to CEOs and CFOs.

Let's change the subject. According to US magazine, Drew Barrymore takes the subway and makes her own clothing. Probably to save money. But no, let's not discuss economic policy. Just once, couldn't we talk about something else?

Sam Uretsky is a writer and pharmacist living on Long Island, N.Y.

From The Progressive Populist, October 15, 2006

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