April 17, 2015
"to elevate the condition of men--to lift artificial weights from all shoulders, to clear the paths of laudable pursuit for all, to afford all an unfettered start and a fair chance, in the race of life."
--Abraham Lincoln
This week the Senate passed H.R. 2, a bill that changes the formula governing how Medicare pays physicians. The legislation was praised by as a “permanent” doc fix. And this is true inasmuch as the recurring doc fix crisis was a function of Medicare’s sustainable growth rate formula, which Congress created in 1997 and repealed with H.R. 2.
But those who are in charge of Medicare have made it clear that there’s nothing permanent about the new physician-payment structure established by H.R. 2. According to a report issued last week by Medicare’s actuaries, “under the new payment system, most doctors will see cuts in 2025.”
Given the importance of the Medicare program to America’s seniors and doctors, it’s worth asking: how did we end up with a bill that replaced one unsustainable cost structure with a slightly different unsustainable cost structure? Why didn’t we just redesign the program to make it fiscally sustainable over the long run?
As I see it, the answer is simple: in Washington, the past dictates the terms of our debate about the future.
In fact, most of our government dysfunction today is rooted in the same failure of imagination.
When the Highway Trust Fund runs dry every year, we have another debate over raising the gas tax, rather than eliminating the bureaucratic and special-interest overhead that drives up the cost of our transportation system.
And when college tuition keeps rising, while success rates keep dropping, we focus on pushing more taxpayer money and more students into the broken system, instead of opening up alternative pathways for people to get the skills they need to get a good-paying job.
And when health care costs refuse to go down, we refuse to believe that hospitals and doctors can manage themselves better than expert committees and bureaucratic agencies.
It doesn’t have to be this way. We can do better. And I’m confident we will do better once we recognize that the real obstacle to reform isn’t a lack of funding from American taxpayers, but a lack of imagination from their elected officials.
