Doctors Oppose Giving Commission Power Over Medicare Payments
By JACOB GOLDSTEIN
Proposals from the White House and Congress to give an independent commission significant power over Medicare payments are drawing opposition from the American Medical Association and the American College of Surgeons.
Both groups have thus far supported significant pieces of the Democrats' health-care agenda, and President Barack Obama has repeatedly cited physicians' backing for his health-overhaul plans.
Doctors objected to a proposal by White House budget director Peter Orszag, shown above in New York last week.
But doctors are objecting to proposals that would allow a federal commission to set the size of Medicare payments to doctors, hospitals and other health-care providers. Under a proposal from White House budget director Peter Orszag, if the president accepted the commission's recommendations, they would automatically take effect unless Congress acted to block them.
Doctors' objections to the commission idea highlight the difficulty of maintaining the support of different health-care constituencies when the focus turns to controlling costs.
Surgeons would "vigorously oppose" legislation that gave an unelected executive agency power to set Medicare rates, said the American College of Surgeons, which claims more than 74,000 members, in a letter to House Speaker Nancy Pelosi last week. Several surgical-specialty societies also signed the letter.
The AMA, which claims 250,000 members, said a commission shouldn't be authorized to set Medicare payment rates for physicians. "If the solution is we're just going to have a big board that will make draconian slashes, that's not getting at the root cause of what the problem is," said AMA President J. James Rohack.
The AMA also argued that Congress already has a provision in place intended to slow the rise of Medicare payments to physicians.
That curb on payment levels has repeatedly been overridden by Congress in the face of pressure from doctors' groups fighting scheduled pay cuts.
As a result, Medicare payment rates to doctors are now roughly 20% higher than levels called for under the cost-control provision. The AMA and the surgeons' group both backed the health-care bill House Democrats introduced earlier this month, in part because the legislation would retain the higher payment level for physicians.
The House bill, however, failed to do much to control the federal government's rising health-care spending, according to the head of the Congressional Budget Office.
Mr. Orszag has argued that his proposal for an independent commission, or a similar measure introduced in Congress earlier this year, could reduce "unnecessary costs" in the health-care system. But in a letter last weekend, the CBO estimated that the Orszag plan would save only $2 billion by 2019. Mr. Orszag responded that the proposal was aimed at the longer term.
President Obama has actively courted physician support for the health-care overhaul. He addressed an AMA meeting in June and said last week that "the nation's largest organizations representing doctors...have embraced our plan."
But the doctors' groups have been far from united. Medical societies from six states and the District of Columbia, along with several other physicians' groups, last week wrote to Rep. Henry Waxman (D., Calif.) to oppose provisions in the House bill, including a government-backed insurance plan and requirements for individuals to buy insurance and employers to offer it or pay a fee.
The bill was backed, however, by the American Academy of Family Physicians, which claims more than 94,000 members. The group also said it would support giving power over Medicare payments to an independent commission if it included at least one primary-care doctor and members from both the public and private sectors.
Another doctors' group, the American College of Physicians, which claims 129,000 members, also backed the House bill. It hasn't taken a position on the proposals involving the independent Medicare commission.
Write to Jacob Goldstein at jacob.goldstein@wsj.com
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Any doctor supporting this adminstration needs their own heads examined.
