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'Doc fix' Medicare compromise has a tale to tell about Congress

Political commentators are praising recent bipartisan action in Congress to fix flawed legislation from 1997 that led to 12 years of “doc fix” votes.

Given the unbending partisan divisions that have characterized Congress for the past decade, any compromise legislation is worth celebrating. But, in this case, the story behind the “doc fix” is equally telling — and not something that makes Congress look good.

Early this week, the Senate passed, with a 92-8 vote, a piece of legislation that the House passed 392-37 last month. The usually divisive House got behind a compromise bill promoted by Majority Leader John Boehner, R-Ohio and Minority Leader Nancy Pelosi, D-Calif. As with any compromise bill, Democrats didn’t get all they wanted in the bill, nor did Republicans.

The passage of the bill changing how Medicare pays doctors will end the annual farce of Congress voting 17 times over 12 years to postpone scheduled reductions in Medicare payments to doctors that were part of a plan to reduce health care spending passed by Congress in 1997. With each year’s vote to cancel the cut in Medicare reimbursements to doctors, the next year’s scheduled cut became larger — and was again postponed by Congress.

Since 2003, Congress voted, often near the end of the year in a semi-panic mode, to pass another “doc fix.”

In 1997, Congress passed legislation to trim Medicare payments to doctors to slow health care cost inflation. After a year or two of reduced reimbursements, doctors, through the American Medical Association, protested to Congress and suggested further cuts would cause some doctors to stop treating Medicare patients. So, for 12 years, Congress acted 17 times to delay the scheduled cuts to doctor’s payments.

The regular doc-fix votes became a joke, and they said something about Washington. The plan for years of small cuts to doctors treating Medicare patients was widely criticized outside and inside of Congress as “dumb” and “bad policy.” Everyone knew it wasn’t working, but it still took 12 years to finally fix the doc-fix.

The original bill was no doubt praised by congressional leaders as a significant step in controlling health care costs. But within a year or two of passage and with little fanfare or publicity, Congress began a decade of predictably voting to negate the very cost-control measure it once praised itself for passing.

The just-passed bill ends the “doc fix” problem, providing for minor increases in doctors’ reimbursements. It also shifts doctors away from today’s “fee for service” billing model where more treatments and tests generate more income. The new payment model is based on quality of care, not quantity.

While that makes sense, there could be trouble with implementation. Another minor controversy related to the just-passed bill is that its costs are not fully paid for. Some costs are covered by trimming payments to hospitals and nursing homes, but the bill’s total cost — $211 billion over 10 years — is not fully covered.

Health care price inflation was, and remains, a serious problem. It probably was not a good idea to impose yearly reimbursement cuts, reducing physicians’ pay for treating Medicare patients. But the many votes to put off each year’s cut, without finding a permanent solution to the doc fix problem for more than a decade says a lot about Congress.

Let’s hope the “doc fix” fix will lead to a more functional Congress and one that finds more opportunities for compromise.

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