Rx for Medicare
THE PRESIDENT of the American Medical Association made a strong case this week that Medicare reimbursements to physicians are too low. His arguments would be more persuasive if he and his organization endorsed the repeal of some of President Bush's tax cuts, so the government could afford to pay the higher rates.
J. Edward Hill, a family physician from Tupelo, Miss., is well positioned to make the case for higher taxes. A resident of a staunchly Republican state, he heads an organization that, though professedly nonpartisan, is traditionally associated with Republican positions. He estimated that the AMA political action committee gives 60 percent of its contributions to GOP candidates.
Yet at a meeting with Globe editorial writers, Hill said that the AMA House of Delegates hadn't considered the matter of tax revenue. ''It would be an interesting debate," he acknowledged. Many physicians have benefited from the tax cuts and would have to balance their own interests against the long-term needs of their profession and patients. Medicare Part B, which pays for physician services, depends on both premiums from the elderly and general tax revenue. If it doesn't get enough from taxes, the elderly will either be forced to pay onerous premiums or physicians will get lower reimbursements. Some will cut back their Medicare caseload in favor of more lucrative business. Neither option is acceptable, especially when millions of baby boomers will become eligible for Medicare in the next few years.
Unless Congress decides otherwise, Medicare physicians' rates will be cut by 4.6 percent next year to control spending. This is a complicated issue, since rates vary by specialty and location, and federal officials are working with doctors to devise a system that emphasizes preventive care over costlier treatments. And Medicare, from its inception in 1966, overpaid physicians for decades. But this system has been tightened up, and future rates should rise to reflect the increasing administrative and technological costs involved in the practice of medicine.
The AMA is looking beyond its members' self-interest to the societywide problem of providing health insurance to the almost 46 million Americans who now lack coverage. In place of the fragmented system of employer-based coverage, Hill foresees a combination of tax credits and individualized policies to cover every American.
Hill would pay for this system by forcing employees who are insured by their employers to pay taxes on the value of the coverage. This is an intriguing concept, but coverage would be more affordable if it could rely on other federal revenue. The best remedy for the ills of Medicare and the rest of the American healthcare system is a good dose of new tax money.
