Giving doctors the Wisconsin treatment

A Southern Democratic governor seeks a federal waiver to experiment with new methods of Medicaid payments to providers to save money over the long term for a strained state budget.

It is for something akin to managed care in which doctors would participate in networks that get paid for cases, not in fees for each individual service.

A Republican legislator in that state, wife of a family practice physician, warns that this is frightful in that it likely means doctors will stop taking Medicaid patients.

I watched it happen just that way last week. It led me to conclude that we need to say to doctors precisely what Wisconsin Gov. Scott Walker has been saying to unionized public employees.

It is that economically distressed taxpayers cannot be expected to keep lavishing generous public dollars on professional tax receivers. It is that we can cut government payments to doctors without cutting patient benefits, provided that doctors can live on a tad less.

Just as it has not been easy for Wisconsin public employees to abide the perceived insult, so would it be ugly, though in an entirely different way, to behold the physician reaction.

Doctors, to speak generally, would not demonstrate nor would they camp out in a state Capitol.

What a doctor would do instead, most likely, is say ever-so-gently to your grandma that, golly, it looks as though he will have to stop treating her.

It is because, he would say, of what those mean and hypocritical politicians are doing to him on Medicare and Medicaid. He would say that he could not possibly justify his time at those reimbursement rates.

Grandma would go straight home and get on the phone to her congressman. That would be where the rubber met the road.

The congressman would need to be firm, but sensitive. It would help if he could say something truthfully along this line: “These changes your doctor has told you about will not affect his care for you. We are trying to save money in the long term, which means that these changes will apply only to Medicare billings for people now younger than 55.

“We are insisting that you be treated the same as always and we also are insisting that your doctor will have a decade to get ready to operate profitably and maintain quality of care under the new system.”

We could call the doctor’s bluff, asking: “Do you have any idea how many baby boomers are soon to go on Medicare? Before long they will compose the outright majority of medical cases in this country. So do you want them at the reduced government rate, and to find a way to make that rate work for you, or not?

“Could you handle higher volume, please, for a little less subsidy per patient, and could you try to do so, please, without saying irresponsibly and dubiously that the quality of care will be sacrificed?

“And could you please move malpractice reform into a separate discussion for the time being? We must save affordable health care first, after which we’ll turn to your insurance.”

While we are talking frankly, let us tell the rest of the truth. It is that we do not wish to devalue doctors nor do we wish to equate them with public file clerks.

Doctors are indeed more vital. They are entitled to be extolled. They are appropriately valued more than the unionized state employee is valued.

But no one is talking about dragging a physician down to a common wage. We are talking about marginal reductions and new streamlined, phased-in efficiencies on the premise that the American economy has permanently constricted and that everyone, doctors included, needs to hunker in the bunker together.

Just once, please, could a politician tell the straight truth and a doctor, or doctor’s spouse, not whine or feed fear?

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.

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