Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments

Doctors And Patients Will Be Harmed By The Debt Ceiling Train Wreck

Watching the negotiations over the debt ceiling legislation is like watching an impending train wreck.

You see a train hurtling down the track, you see an unobservant trucker about to cross, you know that the train engineer and the truck driver have only a few moments to avert disaster, you try to yell and scream to get them to pay attention before disaster strikes—but you have this sinking feeling that your voice won’t be heard until it is too late.

Well, that is how I feel watching the collapsing negotiations over raising the debt ceiling. Responsible persons in both political parties know that a failure by Congress to authorize an increase in the debt ceiling will create incalculable harm to our country, even though some politicians seem to think that default would be no big deal.

But it would be a big deal, and here is why. If August 2 rolls around and Congress hasn’t authorized the government to borrow more, the federal treasury won’t have enough money to pay its bills. It is a simple matter of arithmetic.

According to a new report by the highly respected Bipartisan Policy Center, the federal government on August 3 would have a cash deficit of $20 billion (obligated spending in excess of revenue collected). On August 4, it will have a cash flow deficit of $26 billion.

On August 5, the daily cash flow deficit would be $31 billion. By, August 9, the daily cash flow deficit would be $39 billion and by August 15, the gap between cash on hand and obligated spending will be a whopping $74 billion. According to the Center, the U.S. government would immediately have to cut spending by 44% creating enormous “economic disruption.”

The Treasury Department would effectively have to choose among 80 million monthly payments so that 40–45% of bills are NOT paid.

Excluding interest on the debt, Social Security and Medicare and Medicaid are next in line in obligated federal spending, followed by defense contractors, unemployment insurance benefits, and military active duty pay.

Given the cash flow shortfall, “Handling all payments for important and popular programs (e.g., Social Security, Medicare, Medicaid, Defense, active duty pay) will quickly become impossible.”

As a result, many service providers would be unpaid, including Medicare and Medicaid providers (e.g. physicians, hospitals), defense contractors, and individuals now receiving government checks, creating “widespread uncertainty as decisions are made day by day.”

If physicians think that dealing with the uncertainties of Medicare SGR cuts is too much, how about not getting paid at all for the care they deliver to Medicare and Medicaid patients? Without knowing for how long? With no promise that the government will ever pay them back?

Up until now, much of the debate over the debt ceiling has been about generalities about government spending and taxes, but the numbers don’t lie: failure by Congress to authorize an increase in the debt ceiling will result in millions of people not getting the benefits they’ve been promised and government contractors not getting paid for the services they’ve provided. Not to mention the potential harm to the economy.

And physicians could soon find that they are among those who won’t be paid when the government runs out of cash and Congress won’t let it borrow more.

Today’s questions: What do you think most physicians would do if Congress doesn’t agree to increase the debt limit, and the government stops paying them for treating Medicare and Medicaid patients? What would the impact be on patients?

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

You may also like these posts

    None Found

Read comments »

Comments are closed.

Return to article »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »

Commented - Most Popular Articles