What they’re saying on the doc fix: “Don’t increase the deficit”
Conservative and nonpartisan voices say Congress should fully offset the repeal of SGR…
“Funding a fix is crucial. Last year, the Medicare actuaries estimated that the 75-year cost of an unfunded Medicare doc fix would add another to $2.3 trillion to the already enormous unfunded liabilities of the Medicare program.
“Now, the alarming news. According to Politico Pro, staff level negotiations in the House of Representatives are focused on paying for a relatively small portion of the doc fix, saddling taxpayers with tens of billions of dollars — in extra obligations. Worse, the report advises, the negotiators plan to rationalize not finding offsets by arguing that the SGR was just a “budgetary gimmick” anyway. Such a combination of cynicism and fiscal irresponsibility, if it came to pass, would be breathtaking.”
“In total, now, lawmakers have offset 132 out of 135 months of doc fixes since 2004 with equivalent savings, or 98 percent of the time. Even disregarding the few times small gimmicks were used, policymakers still paid for these delays 94 percent of the time – with almost all of those savings coming from health care programs.
“Although the SGR clearly has not functioned as intended, it has served as an action forcing mechanism to prompt targeted health reforms in place of its prescribed blunt, across-the-board cuts.
“Lawmakers should go further than the current discussions and pay for the entire package, not just a small portion.”
“[S]uccumbing to [this deal] would set back the cause of long-term fiscal reform. To repeat, the sustainable growth rate has not quite worked as intended, but at least its failure never turned into a source of higher deficits. Instead, both parties should treat this as a chance to impose more structural changes, over and above the $37 billion worth contemplated. The Committee for a Responsible Federal Budget has identified $215 billion worth of medical program savings that could help pay for a long-term doc fix without altering eligibility or other fundamentals in either Medicare and Medicaid.
“For all the polarization and partisanship of a dysfunctional Congress, Republicans and Democrats have proven many times that they are still capable of agreeing to spend more on entitlements and pay for it through borrowing. They should miss this opportunity to prove that yet again.”
Bounce the ‘dox fix’ – but don’t increase the deficit
“Last year, the permanent “doc fix” failed because Congress was unable to agree on how to pay for it. This year, Congress wants to cover only part of the cost with Medicare savings. That would be a serious mistake. …
“The bottom line is clear. By not finding offsets for the entire cost of the doc fix-CHIP proposal, Congress is opening the door to even greater deficit spending in the future…
“If we cannot reform the entire Medicare physician payment system, we should at least find other savings in the program to avoid adding greater burdens on taxpayers and their children.”
“The SGR has been denounced as a mere budget gimmick, which in a sense it is, but it is one that has been nonetheless effective: Congress has shown no willingness to actually reduce physicians’ Medicare payments, but it has been surprisingly rigorous about offsetting those doc-fix expenses with other spending reductions. …
“The worst outcome — abandoning those spending restraints while doing little or nothing to mitigate the fiscal impact of doing so — is, unfortunately, what is currently under consideration. If presented with that option, conservatives should put their foot down — on the neck of this profligate, deficit-swelling deal.”
“So sure, the SGR is a failure, as is always the case when price controls stand in for genuine, market-based reforms. But that does not mean Congress should eliminate it without any sincere plan to manage Medicare’s untenable trajectory. Cosmetic trimming and deficit spending simply do not suffice. If the GOP-controlled Congress would like to do something about the tradition of the “doc fix,” it should begin by addressing long overdue structural changes. …
“And in the meantime, Republicans, pay for what you say you are going to pay for, and don’t deceive the taxpayers who sent you to Washington to restore fiscal sanity.”
Brookings Institute’s Kavita Patel (in a joint op-ed with Heritage’s Bob Moffit):
“Congress must make sure that any [SGR] replacement should be fiscally responsible…the cost of any permanent fix to the formula should be offset by permanent Medicare savings.”
“The doc-fix drama is not the thing that needs to be cured, but rather Medicare’s rising and unsustainable costs.
“As a symptom, the recurring annoyance of the doc-fix is actually a good thing. It forces Congress to confront the issue repeatedly. The hope is that someday — with the right Congress and president in place — this confrontation will lead to much-needed Medicare reforms that come with support from a medical establishment eager for a permanent doc-fix. This strategy threatens to make that possibility less likely. There exists a danger that if this deal removes the repeated annoyance of the doc-fix, Congress will lose its best short-term incentive to reform the program for the long term.”