- The Washington Times - Tuesday, January 26, 2010


When President Obama stands before the nation to give his State of the Union address, he might want to set his health care reform sights a little lower, focusing on fixing the parts of the health care system already run in Washington. The president’s human desire for care of the sick is worthy. As a practicing doctor, I see the realities and shortcomings of our health care system every single day. What I don’t understand is why Mr. Obama and his advisers are fighting to expand health systems that can no longer afford to take care of the sick.

Case in point: the Mayo Clinic. It’s being touted as a role model for all of us physicians and hospitals to emulate.

The president proclaimed the following at a rally in September: “Look at what the Mayo Clinic is able to do. It’s got the best quality and the lowest cost of just about any system in the country. … We want to help the whole country learn from what Mayo is doing.”

However, the Mayo Clinic in Scottsdale, Ariz., has recently decided to stop accepting Medicare patients at its primary care facility. More than 3,000 patients will have to start paying cash, or they will have to look for new physicians. Don’t be surprised if the Mayo Clinics in Florida and Minnesota are next.

In 2009, the Mayo Clinic lost $840 million on its Medicare patients. At the Arizona clinic, a Mayo spokesman told Bloomberg News, Medicare reimbursements covered just 50 percent of the cost of treating elderly primary care patients. Not even the Mayo Clinic can survive like that. For the record, the Mayo Clinic is a great institution, but it cannot fabricate money like Congress can.

In 2008, the independent Medicare Payment Advisory Commission reported that 29 percent of Medicare beneficiaries - more than one in four - have trouble finding a primary care doctor willing to treat them. A survey by the Texas Medical Association that year found that just 38 percent of the state’s primary care physicians were accepting new Medicare patients.

Remember that the president has been banking on Medicare and Medicaid expansion to cover many uninsured Americans. The problem is that both systems are nearly bankrupt. In fact, of the 37 million “uninsured,” many are eligible for Medicaid but have not applied, so they are uninsured in name only. There must be a reason they don’t want it. Back to Medicare, the current Senate version still has a 21 percent reduction in payments to hospitals and doctors. Oh, excuse me - there is a one-year extension before the reductions take effect. This is a key component of Obamacare in both House and Senate versions.

The Centers for Medicare and Medicaid Services, a branch of the Department of Health and Human Services, estimated last month that the Senate bill would remove $493 billion out of Medicare over the next 10 years. As a result, it cautioned, “providers for whom Medicare constitutes a substantive portion of their business could find it difficult to remain profitable and … might end their participation in the program (possibly jeopardizing access to care for beneficiaries).”

The Medicare program was initiated in 1965 and was to be financed by a payroll tax of 2.9 percent on self-employed individuals and a similar tax on those employed, with half paid by the employee and half matched by the employer. Just 40 percent of total Medicare funding now comes from the Medicare payroll tax; a nearly equal amount comes from general government revenues.

Medicare is a tremendous drain on our health care resources. The long-term unfunded liabilities of Medicare are a whopping $38 trillion. In 1966, the year after it was created, Medicare cost $3 billion for the year. This past year it was $453 billion. The reimbursements to physicians and hospitals are so stingy as to be laughable if the situation were not so serious. It will only get worse. Today, nearly four workers contribute payroll taxes into Medicare for every enrollee receiving benefits. That number will drop to 2.4 workers by 2030.

I do applaud the desire and need for health care reform, but maybe our president’s advisers and congressional leaders should rethink their health care business model. They remind me of the old saying about the student who learned less and less about more and more until he knew nothing about everything. In this, the president and Congress have succeeded.

Dr. Peter Weiss, an adviser to Sen. John McCain’s presidential campaign, is director and founder of the Rodeo Drive Women’s Health Center in Los Angeles and a contributor to Pajamas Media.

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