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Healthcare Reform: Digging Out Of The SGR Hole

Friday, the Senate — in a rare stroke of bipartisanship — voted by unanimous consent to reverse the 21 percent SGR cut and provide positive updates of 2.2 percent through November 2010. The legislation is fully paid for by offsets in other spending programs.

Unfortunately, though, the cut remains in effect and claims are being processed at reduced rates, because the House of Representatives has recessed for the weekend and won’t be back until Tuesday. At that time, I expect that the House will pass the Senate’s six-month reprieve and Medicare will make doctors “whole” for the period of time that the cut was in effect.

Not that any of this is a cause for celebration. In the meantime, claims still are being paid at reduced rates, creating havoc for physicians and patients. Kicking the can down the road for another six months doesn’t get us any closer to a permanent solution. It doesn’t lower the overall cost, now estimated at over $200 billion, to dig out of the SGR hole. It doesn’t provide the stability and reliability that physicians and patients need to view Medicare as a trusted partner. It does mean that we will be back again, this summer and fall, fighting to forestall another double-digit cut.

My views on the current SGR mess were quoted Friday by Politico:

“With nearly three weeks worth of Medicare bills being paid at 21 percent below ‘normal’ levels, providers are getting angry. The American College of Physicians (ACP) warned that lawmakers of both parties are ‘playing with fire.’ I have never seen physicians more frustrated with the cuts and cynical about Congress’ willingness or ability to do the right thing for patient access, ACP lobbyist Bob Doherty told Pulse.”

Now, with the latest developments on the SGR, we are being accused (again) by some of failing to ensure that the SGR would be taken care of in the health reform law itself. That’s interesting, because it ignores the facts leading up to the current SGR mess. It also overlooks the multitude of other policy reasons why ACP supported healthcare reform.

As I wrote Friday in response to my earlier post “Who Should Doctors Be angry At?”, ACP supported healthcare reform legislation because it advanced ACP policies to provide almost all Americans with affordable health insurance coverage, to end insurance practices that deny people affordable coverage because they have a pre-existing condition or lose their jobs, to create incentives to train more primary care physicians, to pilot-test innovative payment and delivery models like the “Patient-Centered Medical Home,” to fund research on comparative effectiveness of different treatments, and to cover preventive services with no costsharing.

Policies that will help keep alive the tens of millions of Americans that studies show die each year because they lack health insurance. Without healthcare reform, the Census Bureau estimates that more than 60 million people, one out of five of us, would lose health insurance over the next decade.

We supported healthcare reform because it begins to reduce the disparity in Medicare and Medicaid payments for primary care.

We supported healthcare reform because it will allow for pilot-testing and expansion of innovative programs to reduce the rate of increase in healthcare spending.

I will put our record against anyone’s of successfully influencing the legislation to include policies long advocated by internists, particularly on coverage, workforce, and payment and delivery system reforms.

Our support was not unqualified. As I have stated many times before, there are parts of the law that we don’t like, but on balance, the legislation was the right thing for patients.

It would have been the height of cynical deal-making, the kind that our critics decry, for us to say that the only policy that mattered in the healthcare reform debate was repealing the SGR. The SGR is important, but it doesn’t trump every other policy designed to make affordable healthcare available and affordable to tens of millions of Americans. We would never cynically trade all of our other policies to support better patient care in order to achieve a single policy objective, even one as important as the SGR. The SGR matters, but so does providing almost all Americans with access to affordable coverage.

And, let’s be clear on the history: the SGR was passed by a GOP-controlled Congress and signed into law by a Democratic President, Bill Clinton, in 1997. The current state of affairs exists because Republicans and Democrats alike for more than a decade have failed to work together in a bipartisan fashion to enact a system to replace the SGR. We would have been dealing with the SGR even if health reform had never seen the light of day.

Finally, I sincerely doubt that those who now criticize our support of the healthcare reform legislation because they philosophically disagree with its overall approach would be supporting it now if the SGR fix had been included in it. Let’s at least be honest on this point.

Today’s question: What do you think about the efforts by critics to link healthcare reform and the SGR?

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

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One Response to “Healthcare Reform: Digging Out Of The SGR Hole”

  1. Benita Kurtzman says:

    There is a total link between the SGR and healthcare reform. Congress passed a bad bill in 1997 and did nothing to repeal it, until voting not to do so in 2009. There excuse was it was not paid for. The healthcare reform bill stripped more than $500 billion from Medicare and did not use one cent to help pay for an SGR fix. Congress can not vote for an SGR fix because it exposes the premise behind the true costs of reform as a lie. All that the healthcare reform bill accomplishes is 100% negated by the mass exodus of physicians if the SGR cuts go through. I know you are on the defensive now, because of the sword both the democrats and republicans are hanging over our head (and allowing, this time to cut us), but you were warned about that by every doctor in America (except for the trustees of the AMA). It is time to stop being defensive, admit that you blew it, and look for a solution.

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