We have a failure to communicate

The cardiologist called again. It was not about my heart. It was about my politics.

This is the guy from out of town who gets so irritated sometimes by what I write about Medicare that he cannot resist burning my ear.

He calls on the land line telephone that he tells me I had best keep in case I ever wind up on a pacemaker. Apparently you cannot accomplish the essential remote monitoring of a pacemaker via a wireless telephone.

Our occasional conversation began last year when I wrote about getting irate that a pulmonary specialist had told my mom that he probably would need to stop taking Medicare cases because the Obama administration was reducing the consultation reimbursement he got from referrals like hers.

What had happened was that federal Medicare administrators, in an effort to rekindle interest in the family practice business so that people would have plenty of options for cost-cutting preventive care, were jacking up reimbursements for general visits to family practice doctors. In turn, they were proposing to reduce what Medicare paid for basic office visits with big-dog specialists.

My cardiologist buddy said he didn't see many GPs in the emergency room at 3 a.m., fighting to save the life of a patient with touch-and-go surgery. He said he didn't know many GPs who had to invest in the expensive office equipment that a cardiologist's practice required.

He said a specialist's consultation with a referred patient takes time, encompassing a detailed report. He said general practice doctors see patients of all ages while a heart doctor sees people with heart problems, meaning mostly older people likely to be on Medicare.

He said Medicare administrators were trying to save money by squeezing heart doctors out of their own independent businesses and into affiliations with hospitals.

That was the point at which we encountered some kind of communicative disconnection.

He thought that was a bad thing, having, that is, all the cardiologists affiliated inside hospitals. My view was that, with health care costs skyrocketing, streamlining the heart doctors made economic sense, sort of like consolidating school districts.

Maybe we need hospitals to do to health care what Wal-Mart did to retail.

The cardiologist called again last week because I had bugged him anew by saying that U.S. Rep. Paul Ryan and the Republicans were proposing to destroy Medicare.

He said they were trying to save it by converting if from a single-payer program that no longer works. He said they were trying to reform it into a wiser system of government subsidies for private insurance that would give the profit-seeking marketplace some "skin in the game" on the imperative of controlling costs.

So, sigh, there we were again, communicatively disconnected.

It seems to me that one way to cut Medicare costs is to reduce reimbursements to specialists to encourage them to consolidate into more efficient arrangements, maybe with hospitals.

It seems to me that these reduced reimbursements would be better than forcing Medicare recipients into a private insurance marketplace that exists in subservience to stockholders whose "skin in the game" is otherwise known, at worst, as greed, and, at best, as a dividend.

Oh, and another thing: The cardiologist says the solution is not for the government to steal for general use the wealth belonging to any individual. That's simply not right, he said.

But I'm thinking a higher marginal tax rate on the very tip-top portions of our highest incomes is not stealing, but progressive policy.

I'm also thinking we could save high-end doctors a little on those highest marginal tax rates if we reduced their Medicare reimbursements.

The first challenge, of course, will be breaking through these communicative disconnections, not that my phone pal and I have shown the way.

John Brummett is an award-winning columnist for the Arkansas News Bureau in Little Rock and author of "High Wire," a book about Bill Clinton's first year as president. His e-mail address is jbrummett@ arkansasnews.com.