Congress must begin fixing broken Medicare physician payment system

OPINION:

With the election behind us, Congress is returning to Washington to tackle must-pass legislation to keep the federal government running. But before lawmakers finish business for the year, they must also address some of the serious issues Americans are facing with our health care system.

If you’ve encountered long waits for doctor’s appointments, overflowing waiting rooms and lightning-quick examinations, you’ve experienced the symptoms of a growing problem: Our health care system has too few doctors struggling to see too many patients. Market forces have been tossed aside in favor of a government-run system where bureaucrats dictate prices and access.

While the physician shortage has several causes, our health care system is failing doctors, and the Medicare Physician Fee Schedule — the system Medicare uses to reimburse physicians — is the leading culprit.

Unlike services provided through hospitals, hospices and skilled nursing centers, Medicare reimbursement for the care provided by independent physicians is not tied to inflation. As a result, doctors are losing money for each Medicare beneficiary they treat, leaving them with the untenable choice of refusing to treat our most vulnerable citizens or make ends meet for their office and staff. Many of them, especially those who are small-business owners, are quitting out of frustration.

So it’s no wonder that Medicare’s board of trustees warned again this year that availability and quality of services in the program will decline — signaling that our country is following in the footsteps of other failed health care systems.

A recent white paper by Wayne Winegarden at the Pacific Research Institute examined how income price controls, like those included in the Medicare system, intensified doctor shortages and undermined patient access to care. According to the paper, Canada, Germany and the United Kingdom are undergoing extreme physician shortages. As in the U.S., the reasons for the shortages are complex. Physician under-compensation, however, stands out as a strong contributing factor.

The British Medical Association states that “while workload and waiting lists are at record highs, a crippling cost-of-living crisis, burnout and well below inflation pay rises risk driving hard-working doctors out of their profession at a time when we need them more than ever.” Junior doctors in the U.K. have seen their pay cut by over a quarter since 2008.

In Canada’s nationalized health care system, nearly 22% of citizens do not have a family doctor or nurse practitioner. In Germany, an estimated 5,000 to 8,000 doctors’ practices are expected to close in the next three years.

There aren’t enough medical students to replace these doctors in all three countries, a trend that is frighteningly familiar. Data from the National Resident Matching Program paints a similarly dire picture in the U.S., as roughly 2,500 residency spots went unfilled on this year’s Match Day for medical residents.

Physician shortages in countries with heavy government price controls should serve as a warning to Americans that “Medicare for All” would further devastate our already struggling health care system. Our health care services should move away from government control and toward a more free-market system that allows prices to accurately reflect supply and demand. In other words, the more socialism in the system, the less responsive doctors are to patients, because they will exist at the discretion of government.

Our aging baby boomer population needs more high-quality care, not less. Our citizens deserve better.

Policymakers must confront the price controls that push doctors out of medicine and hobble patient access to quality medical care.

Thankfully, House lawmakers have put a promising reform on the table. Recently, Reps. Greg Murphy, North Carolina Republican, and Jimmy Panetta, California Democrat, introduced the Medicare Patient Access and Practice Stabilization Act, which would cancel the planned 2.8% cut to physician payment for 2025 and give doctors a 1.8% inflationary adjustment. If passed, this bill would help us address damaging price controls and allow physicians — particularly those in solo and private practices — to keep their doors open.

In the upcoming lame-duck session, Congress must put physicians in the Medicare system on an economically sustainable reimbursement schedule that is tied to inflation. Doing so will help ensure that older adults can access the care they need. Without action, we risk the United States taking further steps down the disastrous path toward a fully socialized health care system that benefits no one.

• Brian Darling is former counsel for Sen. Rand Paul, Kentucky Republican.