Critical Condition

NRO’s health-care blog.

The Medicare Fee Schedule Has Not Been ‘Fixed’


Even USA Today is reporting what health-policy analysts have known for a long time: Physicians are increasingly unwilling to see Medicare beneficiaries. One would think that a political party committed to repealing Obamacare would use this opportunity to help Americans understand that the government cannot “guarantee” access to health care.

Unfortunately not: Last week, Republican Senators caved in to yet another short-term Medicare “doc fix” that kicks the can down the road until the end of November. Without the so-called “doc fix”, Medicare reimbursements to physicians would have dropped by a fifth as of June 1, as I wrote earlier.

Last Friday’s unanimous Senate vote in favor of “fixing” the fee schedule for a few more months was followed last night by a 417–1 vote in the House. (The lone opposing vote was cast by the very liberal Democrat George Miller.)

What do Republicans think they have achieved by pretending that they have “fixed” the fee schedule? Doctors are fleeing Medicare in droves even with these short-term fixes in place. So, by continuing to share joint ownership of unreformed Medicare with Democrats, Republicans lose (once again) an opportunity to differentiate themselves on health-care reform between now and November.

Perhaps it was necessary for the Senate Republican leadership to carve the “doc fix” out of the horrible “jobs bill” to ensure that the same Republican Senators who voted for the previous “jobs bill” in February did not vote for this month’s budget-buster. Fair enough, but when Senator Reid abandoned the bigger bill on Thursday evening, and Speaker Pelosi brought the stand-alone “doc fix” to the House floor, the House Republicans could at least not have voted for the darned thing.

If Republicans had proposed to junk the entire fee schedule and replace it with a voucher that would liberate patients and doctors to determine how much each medical service is worth, they would have had four months to market this idea to voters, who are quickly learning that Medicare beneficiaries are already facing increasingly limited access to care.

Consider a Medicare voucher for physicians’ services a Beta test for a more universal tax credit, like the one proposed by Senator McCain in his presidential campaign. This is not an easy political lift, to be sure. But if Republicans can’t even do this for Medicare, how the heck are they going to repeal Obamacare and replace it with real reform?


Subscribe to National Review