A Medicare Missive: If We Were to Write to Mr. Bush

Dear President Bush,

Thank you for entering into the dialogue on health care reform in your Jan. 23 State of the Union address and your Jan. 25 round-table discussion in Lee’s Summit, Mo., just down the road from the national headquarters of the American Academy of Family Physicians in Leawood, Kan.

Here in the Heartland, you toured the state-of-the-art Saint Luke’s Hospital East, one of the few completely digital hospitals in the United States. Saint Luke’s is capable of, among other things, monitoring a patient in an intensive care unit nearly 300 miles away in Hays, Kan. Then you met with small-business owners and employees to discuss their frustrations with the current health insurance system. And you touted your plan to offer tax deductions to assist in the purchase of private health insurance.

Family physicians applaud efforts to extend health coverage in our nation. A change in the tax code might increase affordability of private insurance for some Americans. We support the upcoming reauthorization of the State Children's Health Insurance Program, or SCHIP, to care for children in low-income families. And certainly, applause is in order for any plan that would apply common sense to medical liability laws!

But when it comes to fixing the health care system, Mr. Bush, there's an elephant in the room, and you ignore it at the nation's peril. This elephant threatens another group of small-business owners: family physicians who care for patients in communities large and small, urban and rural. Family physicians are the largest cadre of primary care physicians in the United States. If something isn't done about the elephant, Mr. President, Americans may indeed get increased access to care -- but have no one available to provide it.

The elephant is the formula currently used to calculate Medicare physician payments. Virtually everyone in Congress agrees the formula is flawed and must be replaced, but the question is how.

Family physicians have over the years written thousands of letters to Congress and sent their leaders to a multitude of hearings and meetings to address this vital issue. But, so far, the flawed formula stands.

We know that most citizens don't worry about physician payment. But family physicians often struggle to keep their practices open in the face of payments that barely -- or don't -- cover overhead.

The cost of running a practice, let alone upgrading to electronic health records and other technological advances, is often overwhelming in the current payment environment. The technology in the hospital you toured, which you described as "pretty fancy," is far out of reach of the average family physician. Yes, there is a difference between what a hospital and a doctor's clinic need and can afford. But improvements in health information technology are vital to both settings and, in your own words, "hold the cost of health care down."

Furthermore, how many small-business owners could afford a pay decrease of nearly 40 percent over the next nine years? Under the current Medicare formula, that's exactly what would happen to physicians, according to the AMA. Family physicians would be forced to make nearly unthinkable choices about limiting new Medicare patients and even about closing their practices. As the baby boomers add to an already unprecedented number of older Americans and the prevalence of chronic conditions increases, it is heartbreaking and counterintuitive to ask these physicians to make such choices.

In your round-table discussion in Lee's Summit this week, you told the audience, “There is no question in my mind that a proper role for the federal government is to help the poor and the elderly and the diseased get health care.” Please remember, Mr. President, that a revamped Medicare payment structure is vital to make that role possible. Don’t let an antiquated formula keep dedicated doctors from serving the patients who need them.