Plan to Raise Medicare Pay for Providers

Just weeks after rejecting proposals to help the elderly with prescription drug costs, the Senate is poised to increase Medicare payments to doctors, hospitals, nursing homes and health maintenance organizations.

Consumer advocates are furious at the prospect that Congress will address the needs of health care providers without doing anything on prescription drugs, and their anger is putting political pressure on Congress to try again to pass at least a modest drug bill this year.

This is a difficult issue. If one assumes a zero sum game, where should the money go? If we do not increase Medicare payments to physicians, more patients will not be able to find physicians. Physicians are closing their practices to Medicare in droves.

So what is more important, having a doctor or having a prescription drug benefit? I do not know the answer to that question. I am certain that physicians should not lose money seeing Medicare patients. How we address a prescription benefit remains a very expensive and challenging question.

Many lawmakers said that doctors had the strongest claim to new money because their Medicare payments were cut 5.4 percent in January, and they face similar cuts in each of the next two years. Significant numbers of doctors are refusing to take new Medicare patients, saying the government pays them too little to cover the costs of caring for the elderly.

"Unfortunately," said Representative Billy Tauzin, "the Senate has chosen to ignore this growing crisis." Mr. Tauzin, a Louisiana Republican, is chairman of the Committee on Energy and Commerce, which has authority over Medicare payments to doctors.

The House bill would increase Medicare payments to hospitals by $14 billion over 10 years. Hospital lobbyists are seeking twice that amount in the Senate, to help them cope with a shortage of nurses, rising numbers of uninsured and the new threat of bioterrorism.

I guess that I must go back to Congress watching.