Allowing a market in health care

In 1965, Medicare was passed as an amendment to the Social Security Act and the government became the primary payer for medical care for all those over 65. With the stroke of a pen, a health care system that had been centered on individualized care was transformed into at system about population management fervently fixated on cost containment.

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At the time it was clear that Congress appreciated its limitations. It acknowledged a physician’s professional expertise and the value of the sacrosanct patient/doctor relationship. Congress memorialized this acknowledgement in Section 1801 of the Medicare Act as follows:

Nothing in this title shall be construed to authorize any federal officer or employee to exercise any supervision or control over the practice of medicine, or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer, or employee, or any institution, agency or person providing health care services. …  Section 1801, Medicare Act, 1965

Since then, Congress has relentlessly imposed themselves into the exam room and interfered with our opportunity to do what is best for our patients in the name of controlling cost. Government regulations and computer systems designed to invade the privacy of our patients and send bad data back to the government eat away at any semblance of physician autonomy. Repeatedly and assuredly, government intrusion has only led to confusion, wasted resources and added cost.

The concept of Balanced Billing allows the government or any third party payer to pay a fixed dollar amount for a service. The patient pays the difference between the retail price and the “subsidy” paid by the government. Physicians compete and patient choice is preserved. It is a fair market place with a subsidized floor. Balanced Billing was made illegal in 1984 under the Deficit Reduction Act.

The Physician Fee Schedule was established in the late 1980s in an attempt to control the cost of care. Instead, costs escalated and the volume of services continued to increase as would be expected when the fixed cost of managing a physician practice is well over 70 percent.

The SGR was established in 1997 under the Balanced Budget Act, tying physician payments to the GDP. The SGR formula was contrived to ensure that the (increased) Medicare dollars spent per patient was less than the per capita increase in the GDP.

The SGR has proven to be an ineffective means of controlling cost. Every year Congress finds itself with a choice to cut physician payments substantially or “give the physician community a loan.” This is only a budget gimmick serving as a noose around our neck compelling our professional community to allow the government to reduce our discretion as experts and to limit patient choice.

The bottom line: Health care costs continue to skyrocket, patients have fewer choices and physicians find themselves serving the public more as slaves than professionals.

Americans properly expect a trusting relationship with their doctor. However, together with Obamacare, Congress is proposing to further intrude into their medical care. Masquerading as a “fix” to another failed congressional Medicare system of price controls, congress has written the SGR reform bill that serves to create a penalty system that will force doctors to follow government cookbooks and ration care. The SGR reform bill is another contrived financing system that fails to provide quality, affordable health care to the greatest number of Americans.

We are left with a tireless array of manufactured financial systems that serve to address large populations rather than individuals. Failure to allow our patients to voluntarily privately contract and own their lives denies them the privilege of choice.

Congress has decided it is time to get the SGR off its plate. We applaud the decision. In the spirit of limited government, a healthy economy and the First Amendment, America’s physicians ask that Congress do the right thing and finally get out of the exam room and allow America’s physicians to work for our patients and do our job.

Marcy Zwelling-Aamot, MD FACEP, CoChair, National Physicians Council for Healthcare Policy