'Doc fix' trick adds to Medicare debt

Late last week, while still celebrating the passage of its health care reform bill a month ago, the U.S. House of Representatives passed a little-noticed measure that would increase the payments made to doctors under Medicare.

The legislation would prevent the scheduled 21.2 percent cut in Medicare reimbursements for physician services and increase payments to doctors by $210 billion over the next decade.

The trouble with the proposal is not that physicians should not be paid adequately for their work. It is that the House, which has promised deficit-neutral health care reform, would bust the budget with another half-trillion dollars in spending all the while denying it is doing so.

The trickery here is that the resolution also requires lawmakers to show some fiscal restraint. But it makes an exception for the physician payments. The Democrats can claim they are for fiscal discipline, but they'll authorize reimbursements with money they don't have.

The fix is in.

It's true that doctors have either seen or been threatened with significant pay cuts for years. That effort to contain the growth of Medicare spending has had a ripple effect. Physicians say they can't afford to see Medicare patients. Patients then have a difficult time getting access to a doctor at an age when they tend to need one more often.

Congress understands this, or if lawmakers don't, lobbyists make them listen. Since 2003, Congress has overridden scheduled cuts in payments every year.

What this legislation suggests is that the House, at least, is not willing to tackle the issue and would leave it to future generations to pay off new debt. It's tantamount to fraud to fail to treat the extra payments to physicians in the context of broader reform.

Senate Majority Leader Harry Reid tried something similar in the Senate. Reid's bill called for a $247 billion "fix." He offered it as a stand-alone bill, but the measure was blocked when 13 Democratic senators joined all 40 Republicans to stop it. They knew it was too expensive.

Here's how U.S. Rep. Paul Ryan of Wisconsin described the Senate effort:

"Consider a congressional credit card for health care: It is already maxed out, yet there is more spending politicians want to do. So Congress pulls out another credit card - in the form of separate legislation - and racks up another quarter-trillion dollars of spending."

The Democratic leadership appears willing to play a congressional shell game.

Determining physician Medicare payments is a complicated and difficult issue, but it's not going to be solved by pretending continual increases to the current formula aren't putting the budget into a deeper hole.