For years now, Congress has returned again and again to the so-called “doc fix” – the temporary patch by which Congress saves doctors and hospitals from sharply reduced reimbursements for treating the elderly and ill under Medicare. In order to prevent the cuts, Congress must repeatedly apply a patch, as it once did to forestall the Freedom to Farm Act and the Alternative Minimum Tax.
This is a lousy way of doing business — but it isn’t all bad.
House Speaker John Boehner, R-Ohio, is now trying to cut a deal with House Democrats that would break the pattern. In order to get rid of the periodic “doc fix” drama once and for all, he hopes to pass a reform bill that reins in Medicare costs in the very long run. The compromise in the works would reportedly raise out-of-pocket costs for seniors with incomes over $133,000 and couples above $266,000. The reform package would also discourage over-utilization of Medicare by instituting minimum cost-sharing in so-called “Medigap” plans.
In the long run, these reforms will save money, but unfortunately the savings build very slowly. Many conservatives are upset at this plan – and upset that Boehner is making it with Democrats behind their backs – because it increases the national debt by $130 billion during the ten-year window in which Congress typically budgets.
Defenders of the deal may be correct that the savings are greater in the long run, but it’s a very long run. And even though this may override the arguments about spending levels, there is another important consideration that affects the long-term prospects for thorough reform.
Until now, Congress has applied the doc fix over and over again, in each instance without deeper Medicare reforms. But it has at least cut spending each time to offset the cost of restoring full reimbursements to doctors and hospitals. It’s a lousy way to do business in general, and in fact, it highlights what’s wrong with Washington. But it is a symptom – not the disease. The doc-fix drama is not the thing that needs to be cured, but rather Medicare’s rising and unsustainable costs.
As a symptom, the recurring annoyance of the doc-fix is actually a good thing. It forces Congress to confront the issue repeatedly. The hope is that someday — with the right Congress and president in place — this confrontation will lead to much-needed Medicare reforms that come with support from a medical establishment eager for a permanent doc-fix. This strategy threatens to make that possibility less likely. There exists a danger that if this deal removes the repeated annoyance of the doc-fix, Congress will lose its best short-term incentive to reform the program for the long term.
So if Congress passes this doc-fix, it may not be the worst thing in the world. But it will be far short of what conservatives need to be aiming for. Fortunately, House Budget Chairman Tom Price, R-Ga., remains dedicated to the long-term reforms contained in the budget first proposed and passed by his predecessor, Paul Ryan.
But in a world where the doc-fix is no longer an issue, Price and his conservative allies will face a tougher battle to keep the Republican Congress’s attention where it belongs – on saving Medicare from itself, and saving future generations of Americans from the unsustainable and irresponsible promises made in the past.
