Sen. Jon Kyl: "What I'm proposing is using one budgetary gimmick to pay for another."


That's Arizona Republican Sen. Jon Kyl's proposed method of "fixing" Medicare's physician reimbursement scheme, the sustainable growth rate (SGR), which has been causing multi-billion dollar budget headaches for roughly a decade. Sen. Kyl's idea is to use imaginary war spending that's currently included in the federal budget baseline to pay for the actual spending on Medicare's physician payments. Problem solved!

Kyl's revealing remark comes via The New York Times, which has a yet another lengthy report on the latest iteration of the long-running fight over what's become known as the "doc fix." The wonky details are there for those who want them, but the larger picture remains depressingly familiar.

As usual, it's total gridlock on Capitol Hill, even though both parties in Congress agree on what they want: Giving doctors a slight raise from their current temporary reimbursement rate, and permanently resetting Medicare's physician payments at a much higher level than the SGR formula calls for. (If no changes are made, physicians will take a 27 percent cut in March.) Doctors, of course, insist on being paid more too, and say they might not be able to take Medicare payments if the low rates go into effect. The hangup, as always, is how to pay for the increased rates.

But the larger problem that tends to go unmentioned is the technocratic mindset, shared by both parties, that assumes that Congress should control payment rates for Medicare, the single largest health payer in the country. As I reported in my January story, "Medicare Whac-a-mole," Congress has been fiddling with centrally set Medicare payment schemes for decades, only to find that each new plan produces a new and unexpected set of unintended consequences, which then have to be fixed through more technocratic tinkering. But surely "fixing" the SGR's problems through an obvious gimmick swap will work where previous attempts to control the system have failed.