Skinny Jeans, Expanded Waistlines, And A Washington 'Fix'

By Scott Horsley

Published March 26, 2015 at 11:50 AM CDT

Congress tries every year to plug a loophole that would otherwise result in a 21 percent cut in Medicare doctors' pay. But it doesn't exactly always tighten its belt in the process.

Every year about this time, after a Washington winter of inactivity, I notice my pants have grown a little tighter. Years ago, I resolved to address this by cutting back on burritos and beer.

But the (ever more abundant) flesh is weak. And burritos are soooo tasty. So instead, every spring I simply let out my waistband a bit, while promising to redouble my dieting efforts next year. I call this, "The belt fix."

Sound familiar?

Nearly two decades ago, Congress made a similar promise to rein in the growth of Medicare's spending on doctors' services. But as soon as the formula — known in Washington as the "sustainable growth rate," or SGR — began to pinch, lawmakers loosened the belt.

You may (or may not) have heard this described as "The Doc Fix." Since 2003, Congress has acted 17 times to prevent a cut in Medicare doctors' payments. But the "fix" has always been temporary, maintaining the fiction that pay cuts would eventually kick in. It's sort of like that pair of jeans with the 32-inch waist you keep in your closet, trusting someday they'll fit.

By now, it would take a crash diet. Under current law, doctors are facing a 21 percent cut in Medicare payments on April 1.

So lawmakers are planning to throw out the old bluejeans and start over.

A bipartisan bill negotiated by House Speaker John Boehner and Minority Leader Nancy Pelosi — and backed by President Obama — would permanently replace the sustainable growth rate with a new formula, estimated to cost $175 billion more over the next 10 years.

Fiscal watchdogs complain that previous "Doc Fixes" have usually included offsetting cuts elsewhere in the health care budget. In contrast, most of the extra spending this time will be added to the federal deficit.

Lawmakers are making modest dietary changes, though. The new formula includes financial incentives for doctors who participate in a new, alternative payment system designed to reward value, not volume of care.

The proposal also includes slightly higher Medicare premiums for wealthy seniors. And it limits "first dollar" Medigap plans, so seniors have an incentive to use health care services more wisely.

All of this probably means doctors won't be squeezing into the skinny jeans of the SGR next week. But if the reforms work as intended, our expanding Medicare waistline should include less flab, and more lean, medical muscle.