Wednesday, October 21, 2009

The Unkindest Cut of All

It was Shakespeare who called Brutus' stabbing of Caesar as “the unkindness cut of all.”

Now senators of today are proclaiming the proposed SGR-based cut of 21%, scheduled for January 2010, and 4-5% more each year thereafter, e.g., 25% in 2011, as the modern equivalent of the Brutus stabbing.

A Medicare cut of this magnitude is unkind to patients in that it might cut off access of patients to doctors. Some 30% of Medicare patients are already having a hard time finding doctors. These cuts would worsen the situation.

The cut is unkind to doctors, too. Many primary care doctors are already struggling to make ends meet. The profession as a whole derives about 1/3 of their total income from Medicare, and the proportion is much higher among geriatricians, primary care doctors, and certain specialists – urologists, ophthalmologists, and oncologists.

If the cuts were to take place, physician polls indicate about 40% of doctors say they would retire, see fewer Medicare patients, or simply not accept new Medicare patients.

Now Medicare cuts have become a central issue in the health reform debate. The papers are full of news on the debate.

Take titles of news stories,

• October 21, “Senate Democrats Hit Snag with Doctor Payment Bill, ” New York Times

• October 21, “Fight over Medicare Cuts Play into Larger Debate,” Wall Street Journal

- October 20, "Senator Compares AMA to A Prostitute," Wall Street Journal Health Blog

Under current law, Medicare doctors payment will fall by 21% next year. Nobody, Democrat or Republican, wants to let the cuts take effect. Congress has repeatedly blocked similar pay cuts. But permanently scrapping the planned cuts would add some $247 billion in federal spending over the next decade.

A Democratic bill ( S. 1776) would permanently scuttle cuts without addressing the higher cost. The would simply take the cuts out of the bill and handle it separately by adding to the deficit.

Republicans favor scrapping the pay cuts, but oppose the bill because it would add to the deficit. They would keep it in the bill, but find ways to pay for it.

Count Bob Corker, a Tennessee Republican said, “I absolutely agree that physicians around this country do not need to take a 25% cut.”

Corker also cited a report from The Hill that said Democratic leaders offered the AMA and other doctors’ groups a deal: The Democrats would block the Medicare pay cuts, if the doctors’ groups would back Democrats’ broader health-care bill.
Corker compared the deal to prostitution,

Corker uncorked this message, “We all know that the selling of one’s body is one of the oldest businesses that has existed in the history of the world. And so the AMA now is engaged in basically selling the support of its body by throwing future generations under the bus by in essence urging that we as Congress pass this week a quarter of a trillion spending bill, unpaid for. And if we would do that we might get their support in health care reform."

The AMA denied this charge and Senators ought to vote for S. 1776 before access to care for patients is further eroded by steep Medicare cuts to physicians.

Latest news? Senate Democrats have backed down. They will not cancel doctor cuts without finding a way to pay for it, e.g. to offset costs. Stay tuned.

Dr. Richard Reece is author, blogger, speaker, and innovation and reform commentator. Dr. Reece’s latest book, Obama, Doctors, and Health Reform ( is available at,, and for $31.95 (hardcover), $21.95 (softcover), and $6.95 (electronic). For information on speaking fees and arrangements, call 860-395-1501

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