I'm a doctor. I have a practice that's mostly Medicare. For several years it has been a "loss leader" for my other job, that pays better -- being Medical Director for a company that does drug trials, paid for by big drug companies.
In about 2003 Congress created a "sustainable growth rate" (SGR) formula for Medicare payments. Basically, if Medicare expenses per person insured went up more than inflation, what Medicare paid the next year would be reduced by enough to bring it back down. That passed the buck for staying within budget to doctors and patients -- collectively. There's no way to enforce that "budget".
Every year, when the SGR reduction reared its ugly head, Congress kicked the can down the road.
This year, I really don't trust them to do it.
Below the orange Fleur de Kos, the email I wrote to my Congressman today:
Should I drop out of Medicare?
Today is MY deadline for deciding whether or not to "participate" in Medicare next year. If you and your colleagues in Congress don't act today and meet YOUR (self-imposed) deadline, I will be faced with a 26.5% pay cut for seeing Medicare patients.
I realize it's possible Congress will reverse that cut, even if it has to be done retroactively. It has happened in the past, when the unreasonable cuts called for by the "sustained growth rate formula" were about to happen or did temporarily happen. But can I trust Congress to do the reasonable thing again, this time around? Trusting Congress to do the reasonable thing is a risky bet. Just ask Standard and Poor why they cut their rating on United States bonds.
Perhaps tomorrow I should ask my office manager to telephone all the Medicare patients who have appointments any time in 2013, and tell them not to come in until this is settled. While she's talking to them, she or I should also give them the telephone numbers of their Congressmen.
I realize you and other members of the Tea Party caucus may feel you "weren't elected to raise taxes". Perhaps not, but you were elected to govern. During the last campaign, at a town hall meeting, a voter who seems to have missed the big picture told the candidate, "Keep your government hands off my Medicare!" My office manager and I may educate a few such folks that Medicare is in fact entirely in the hands of the Federal Government.
Governing requires seeing the big picture, and if necessary, showing it to those being governed. Are you up to that?