CullmanTimes.com - Cullman, Alabama

Opinion

December 13, 2012

COMMENTARY: To cut health care costs, pay doctors less

(Continued)

But that shortage is driven by a funding dispute between hospitals and the federal government, over whether Congress should increase subsidies, paid through the Medicare program, for medical residencies. It has nothing to do with people's desire to become doctors: The number of medical-school applicants this year exceeded 45,000, about 35 percent more than a decade ago.

So what's the answer? One option is to cut Medicare rates for specialists, using part of the savings to fund current rates or even gradual increases for primary-care physicians. That would ease some of the pressure on the broader economy, because Medicare rates affect payments by private insurers. It would also change the incentives that drive so many medical students away from family medicine toward more lucrative specialties.

Another option is to replace the current law on Medicare payment rates, which Congress consistently overrides, with legislation that would reduce payments by a smaller amount for all doctors and link them to the rate of economic growth. Congress has failed to stick to this approach before, but if lawmakers believe their own rhetoric about the dangers of rising Medicare costs, this is one way to act on it.

The government could also make an end run around doctors by allowing nurses and physicians' assistants to do more of the work. That possibility alone, which would reduce the role of doctors, and therefore their leverage, should give them an incentive to compromise.

The solutions aren't easy. But the question isn't whether doctors deserve to be paid less. It's whether they deserve a level of protection that's unlikely to be afforded hospitals, nursing homes or Medicare beneficiaries.

Excluding doctors from spending cuts means greater sacrifice from the rest of the health-care world — including their own patients. That's not a picture Norman Rockwell ever painted.

Christopher Flavelle is a health-care policy analyst for Bloomberg Government.

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