NCPA - National Center for Policy Analysis


October 6, 2009

In President Obama's Washington, medical specialists are slightly more popular than the H1N1 virus. Compared to bread-and-butter primary care doctors, specialists cost more to train and make more use of expensive procedures and technology -- and therefore cost the government more money.  Even so, the quiet war Democrats are waging on specialists is astonishing, says the Wall Street Journal.

From Senate Finance Chairman Max Baucus's health care bill to changes the Administration is pushing in Medicare, Democrats are systematically attacking specific medical fields like cardiology and oncology.  With almost no scrutiny, they're trying to engineer a "cheaper" system so that government can afford to buy health care for all -- even if the price is fewer and less innovative ways of extending and improving lives, explains the Journal.

Take a provision in the Baucus bill that would punish any physician whose "resource use" is considered too high:

  • Beginning in 2015, Medicare would rank doctors against their peers based on how much they cost the program -- and then automatically cut all payments by 5 percent to anyone who falls into the 90th percentile or above. In practice, this rule will only apply to specialists.
  • Since there will always be a missing chair when the music stops, every year one of 10 physicians will be punished if he orders too many tests, performs too many procedures or prescribes too many drugs -- whether or not the treatments result in better patient outcomes.
  • The 5 percent fine is substantial given that Medicare's price controls already pay only 83 cents on the private dollar.

In Medicare, meanwhile, the Administration is using regulation to change how doctors are paid to benefit general practitioners, internists and family physicians, says the Journal:

  • In next year's fee schedule, they'll see higher payments on the order of 6 percent to 8 percent.
  • The loose consensus is that the United States does have too few primary care doctors -- less than 5 percent of medical students are entering the field -- in part because they're underpaid.

Fair enough, but this boost for general practitioners comes at the expense of certain specialties:

  • The 2010 rules, which will be finalized next month, visit an 11 percent overall cut on cardiology and 19 percent on radiation oncology.
  • They're targets only because of cost -- two-thirds of morbidity or mortality among Medicare patients owes to cancer or heart disease.

Source: Editorial, "The War on Specialists; ObamaCare punishes cardiology and oncology to finance GPs," Wall Street Journal, October 6, 2009.

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