What the Devil Are the Details? : GOP’s Medicare cuts leave public in the dark

With their Republican majorities rejecting virtually every amendment and modification offered by Democrats, House committees have wrapped up work on 400 or so pages of proposed Medicare reforms. Coming weeks will give a chance to try to figure out just what has been wrought.

For now, it’s fair to say, most people remain uncertain, confused and in some cases plainly scared about how the effort to trim $270 billion from projected Medicare costs over the next seven years will affect their lives, if not immediately then when they become eligible for the huge government-financed health insurance program for the elderly. Much of that uncertainty stems from the Republicans’ highhanded refusal to hold the kind of open and extensive hearings that both the magnitude of the Medicare program--it cost $178 billion in the past fiscal year and is growing faster than anything else in the budget--and the sweeping changes proposed for it demand. If ever there was a time when the legislative process could have benefited from informed testimony and questioning by all concerned parties, this was it. The failure to permit that shames the congressional leadership.

Among the latest things we’ve learned about the House bill is that it now carries the long-withheld blessing of the 396,000-member American Medical Assn., the result of an agreement by Republicans to substantially ease the financial impact on physicians of the proposed cuts in Medicare’s rate of growth. Instead of cutting reimbursements to doctors by about $26 billion over seven years, the cuts will be about $22 billion, roughly the same as in the Senate measure. Republicans say this favor won’t be made up for by bigger hits on hospital reimbursements or higher costs to Medicare beneficiaries, but they won’t or can’t say just where the offsets will come from. One more mystery waiting to be unraveled.

Absent expert scrutiny of the final bill, there’s no telling what other favors, surprises or unintended consequences might lurk in its many provisions. Possible among the latter, some warn, is that reduced Medicare payments could lead to higher premiums or even the loss of insurance for privately covered workers, as health care providers try to compensate for lower payments from the government by boosting charges to non-Medicare patients. This is a dire possibility that open hearings might have more forcefully brought to Congress’ attention.

There’s no question that Medicare costs must be more rigorously controlled, or that the burden should fall fairly on health-care consumers and providers alike. But there is a lot of scope for deciding how to impose those cost controls, and over how long a period of time. We see nothing, outside of politics, that is irrevocable about the Republican timetable and nothing urgent about that $270-billion figure. What does seem clearer than ever is that, given the complexity of the issue, the wisest course is not to rush to legislate, but to slow things down and take a few years, not just a few months, to weigh what changes are obviously needed.