Medicare and paying the doctors

Sen. John Cornyn:

From Indian medicine men to frontier "saddlebag docs," Texas has a long, rich history of pioneers in medicine. Early Texas physicians often met the medical needs of entire families, traveling long distances on horseback just to provide care.

In more urban settings, such as Galveston, physicians began renting facilities for patients to visit. In 1851, Samuel Hurlbut contracted with the city of Galveston to become the physician for the state's first civilian hospital, treating 250 to 500 patients each year.

In San Augustine, famous Texas Ranger John S. Ford also worked as a family physician. According to medical records in 1844, Ford charged $15 for delivering a baby, $7 for bloodletting and 75 cents for an "itch ointment."

These days Texas is home to some of the world's elite research centers, hospitals and medical schools. The University of Texas Southwestern Medical School employs more Nobel laureates than any other medical school in the world, while Houston's Texas Medical Center houses 13 prestigious hospitals.

From humble beginnings, Texas has made incredible strides in medicine. However, without immediate reforms to the way our government pays physicians under Medicare, we can expect a major decline in the number of physicians available and an ever higher spike in the cost of care.

These negative trends have already begun. A decade ago, Congress tried to curb rising health care costs by implementing an arbitrary cap on physician payments. As a result, physician reimbursements across the country lag far behind actual practice costs. In Texas and across the nation, the gap between physician reimbursements and the costs for delivering care is roughly 15 percent.

To make up the difference in revenue, many physicians have crowded their waiting rooms with extra patients, resulting in rushed visits, less one-on-one time and a lower quality of care.

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If we really want serious health care reform, we need to start with changing the way we pay physicians. We need a system that provides incentives for reduced costs and quality care while protecting the eroded physician-patient relationship.

In the Senate, I've introduced legislation that would pave the way for meaningful physician payment reforms. The Ensuring the Future Physician Workforce Act of 2008 would get rid of the unsuccessful spending cap and focus on improving health care delivery and lowering costs. This legislation would speed up the adoption of health information technology, providing greater information accessibility, safety and savings — all while educating and empowering physicians and beneficiaries. These tools would increase the overall quality of care by boosting competition among doctors, while enabling patients to better engage their physicians and evaluate their care.

Under the current spending cap, the Centers for Medicare & Medicaid Services expect Congress to cut a certain percentage of Medicare reimbursements each year. In turn, Congress struggles to find ways to delay this cut and prevent more physicians from turning away Medicare beneficiaries.

The costs for delaying these cuts, however, are staggering. If a permanent fix is not found, every physician in Texas can expect to lose $18,000 between July 2008 and December 2009.

My bill stops the rate-cut charade and eliminates the reimbursement cap. The effect on spending is the same, but physicians are given fair reimbursements and more peace of mind. As a result, patients would also benefit from more certainty concerning the health care services they depend on.

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If you are ever so fortunate as to see the Texas on the Barzos State Park a few miles from my place you will find the restored home of a early Texas governor and near it is an out building, approximately eight by eight feet that was his medical office. We have come a long way from that small office to the complex known as the Texas Medical Center in Houston and similar large facilities in Galveston, Dallas and elsewhere around the state.

Texas has also benefited from its tort reform laws which has encouraged more doctors to come to the state because of the significance savings on malpractice insurance.

The problem with medical cost and physician reimbursement is caused by the distortions on the marketplace by insurance and programs like Medicare. Sen. Cornyn's plan will put a band aid on the current system and is perhaps the most we can expect in the current political environment. I think medical savings accounts and high deductible insurance is the answer to containing health care cost and that there is probably a way to put them in place for Medicare too.

Sen. Cornyn is running for reelection this year and deserves your support. I think he is one of the most intelligent Senators in Washington and has done a great job for the country.