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Melanie Munk, Features Editor munk@heraldnet.com

Medicare woes way past easy patch job

By Linda Bryant Smith
Herald Columnist

The bandage Congress pasted on Medicare funding five months ago to cover nasty cuts won't hold much longer.

Think of it this way. If you slipped, fell, heard something snap and saw a broken bone protruding from a bloody wound on your leg, would you expect a Band-Aid to take care of your problem? Even if it had a smiley face on it?

So here's comes a fella, he sees your leg and says, "Looks bad, but there's someone coming who might help." A woman stops, looks, goes in her purse and hands you her handkerchief to wipe up the blood.

"I'm sure someone will be along soon, but I've got other work to do."

And so it goes. The bleeding doesn't stop, the leg's in bad shape and there's no real help in sight.

Well, significant cuts to Medicare Part B physician payments have been proposed each year since 2002 and Congress has managed to avert those cuts with a temporary fix (lots of smiley faces for photo ops) followed by promises to really address the serious funding problems for Medicare.

Last winter, with a 10.6 percent cut looming, they tossed on another bandage and delayed action to July 1. Even if they delay it again, an additional 5 percent cut is scheduled for January.

Right now in Snohomish County and throughout the country, many medical clinics and physicians in private practice do not accept new Medicare patients. The most recent statistic I've seen suggests only 57 percent of the doctors in our state accept Medicare patients.

That's for a very practical reason. Medicare reimbursement doesn't cover the actual cost of services.

A medical clinic administrator in Edmonds told me last year that her clinic loses about $12 on every Medicare visit, not including physician's wages. Other doctors I've spoken with, including my personal physician, suggest they actually lose more.

It's not as though Medicare is picking up the full tab for the elderly. Medicare, on average, pays about 54 percent of a recipient's health care costs.

That's why, after they deduct the cost of Part B (which went up again this year) from Social Security, many recipients still pay up to $178 more per month for supplemental insurance to help cover medical expenses and another $25 or $30 for the prescription drug benefit.

That should be of special concern to the aging boomers, 78 million strong, jogging toward Medicare eligibility.

If their physicians retire before they do, who will agree to take them on as Medicare patients? How much will be deducted from their Social Security for Part B? How much will they have to pay for supplemental insurance?

It sure as heck isn't going to be cheaper.

Medical advantage plans, once promoted as economical and efficient alternatives to traditional Medicare, cost taxpayers more than regular Medicare.

In 2006, Medicare advantage plans cost the administration $7.1 billion more than it would have cost to have the same people served through traditional Medicare, according to the Government Accountability Office. That amount is expected to be even higher this year, according to MEDPAC, the commission advising Congress on Medicare spending.

In March, the Medicare trustees issued a report saying reserves in the Medicare trust fund that pays hospital benefits will be wiped out by 2019.

This year, the report said, money coming into the Medicare trust fund will be less than the amount paid out.

Treasury Secretary Henry Paulson, one of the trustees, called the situation a "fiscal train wreck."

For the second year in a row, the trustees' report required the president to recommend solutions for dealing with the shortfall in Medicare taxes and projected benefits.

President Bush recommended, among other things, that wealthier Medicare beneficiaries pay higher monthly premiums for Part D prescription coverage. No action on that yet, either.

There are bills in Senate committees now that will stop the proposed cuts: S2708 in the Senate Finance Committee would increase Medicare patients to primary care physicians; S2785, the "Save Medicare Act" was introduced in March. It would replace proposed Medicare cuts with increases in physician's payments through Dec. 31, 2009.

Given that this is an election year, I expect one of these bills will pass so the folks in Congress can announce that they saved Medicare, so voters should re-elect them by a landslide.

And they won't have saved a darn thing except their sorry hides for a very short time.

The president we elect in November must come with a fiscally responsible health care plan that addresses Medicare's continuing problems.

It must be fair to physicians and hospitals as well as the millions of older Americans and disabled folks who are Medicare recipients now, and also to those who cannot afford health insurance.

He or she must also have a commitment from Congress that members of both parties in the House and the Senate will work diligently to pass legislation implementing such a plan.

As taxpayers -- and, more importantly, as voters -- it's our job to hold these folks accountable. No more Band-Aids with smiley faces.



Linda Bryant Smith writes about life as a senior citizen and the issues that concern, annoy and often irritate the heck out of her now that she lives in a world where nothing is ever truly fixed but her income. You can e-mail her at ljbryantsmith@yahoo.com.