Hazardous to your health

Posted: Dec 27, 2002 12:00 AM
In a world that makes no sense, the Bush administration announced last week that it was reducing Medicare payments to doctors by 4.4 percent starting in March 2003 -- that's after a 5.4 percent cut this year. Doctors' costs haven't decreased, frustrated federal officials admitted. Doctors will get less because of a nonsensical Medicare rate formula set by Congress. "When the economy slows down, payment rates will decrease, under the formula," an official, who wished to not be named, explained. Here's what makes less sense. Even as Medicare policies threaten the ability of seniors to find doctors and receive promised health care -- that is, even as Medicare is having trouble delivering on its commitments -- some politicians -- try former Vice President Al Gore and California state Sen. Sheila Kuehl -- want the government to make more commitments it can't keep. They call it "single payer" -- a universal health care package that promises to move the country's 41 million uninsured residents out of emergency rooms and into the health-care community. They should call it "more promises destined to fail." Look at Canada's single-payer -- and allegedly universal -- health-care system, which has left 900,000 citizens of Ontario without a primary care physician. They call that care? Why would a system that promises to treat everyone leave so many families without a family doctor? Money. It costs money to take care of sick people and money to keep people from getting sick. There was a time when people understood this simple concept and paid for doctor visits and medicine; insurance provided coverage for serious problems. But managed care introduced the idea to consumers that they shouldn't have to pay anything but a nominal fee for their doctor visits; other providers followed suit. Politicians now promise to pay drug benefits for seniors even as they're shorting doctor payments. It's all part of the Holy Grail of health care in America -- getting someone else to pay. In Canada, the government pays, so the government devises ways to pay less. The shortest route: less care. In the United States, parties play pass-on with health-care costs. Seniors want Medicare to pay for their health care; many want to expand benefits to cover prescription drugs. Medicare shortchanges providers who must pass on unpaid costs to consumers. When the pass-ons grow too big to be absorbed, the rhetoric to get other entities to pay gets ratcheted up -- remember, this stuff is supposed to be free -- and politicians promise more benefits while their policies eventually will net less care. Ed Colloff, an internist at Kaiser Permanente in Redwood City, Calif., notes that seniors have complained that Kaiser raised its co-payment fees in response to last year's Medicare payment cuts. They have to understand, Colloff noted, one problem: "Kaiser can no longer afford to subsidize the government." And while patients complain about higher health-care costs, they rarely recognize that the higher costs deliver better care and an enhanced quality of life. In Washington, everyone knows there's a problem, but there is too little incentive to fix it. Besides, when you get to the point where you can't pass on the costs, you can still pass on the blame. It's especially helpful when the public blames not those who fail to deliver, but those who fail to promise big. Tell voters that you support single payer, and that's supposed to be a sign that you care. Tell voters you want to promise only as much care as the government can afford, and you're mean-spirited. Few will give you credit for trying to keep taxpayers who already have good medical coverage from becoming a Canadian-style statistic.