Wednesday, June 25, 2008


Okay who knows what all that stuff is? I do, but, its only because I've been stuck talking about it year after year with very little hope of any realistic improvement. All of these initials have to do with the current Medicare system (especially the last one). SGR stands for Sustainable Growth Rate and it's how our federal lawmakers have tried to limit the growth of Medicare costs. They tied the total amount of money that can be expended to the United State's GDP or Gross Domestic Product. That means the value of all goods and services produced in the US during the preceding year.

Because our economy is, to say the least, less robust than it was a few years ago, coupled with, the increasing number of folks entering the "Medicare years" due to baby-boomers pouring in like a damn busted, the formula stopped working several years ago. Everybody knows it doesn't work; the lawmakers, the doctors, the hospitals, even the HHS folks who administer Medicare know. Guess who doesn't know? For the most part patients have no idea about the costly, intricate dance that goes on every year, with doctors and hospitals spending millions of dollars to convince the lawmakers to do what they know they are going to have to do anyway. And each time they patch it the formula gets farther and farther away from anything approaching reality. We are now so far behind that a 20-22% cut in current reimbursement rates would be needed to set things straight. That, or the jobs we've allowed to be outsourced overseas will have to start spilling back into the US, the dollar will have to drop so low that its cheaper to make things here than it is in China. Think that's gonna happen soon?

The closest thing I can think of as an example, is that if you needed a new car, and you set the amount of money you could spend on that car a year as a set portion of your income. Now, some hard times come. You make less money. Gas goes up to four dollars a gallon. Could you go to the bank and say, “I’m going to have to cut what I’m paying you on this loan.” Or go in to the gas station owner and tell him, “Sorry buddy, but all I can give you is two dollars a gallon.” You’d be a no car, no gas, walking the road son-of-a-gun. And, if you don’t believe me, just try it.

So what do we Americans do if we want the system to function and doctors to treat us when we become geezers, ( I stand on the very verge of geezerhood myself). The answer is simple we need to SCRAP the CRAP. The SGR can't be fixed so start over. The House has just passed another bill to put another bandage on it for 2008-2009, the Senate has yet to act, but if it doesn't the first 10.8% cut is already programmed into the HHS computers for July 1, with another catch up cut of 10.2% set for January 1st. We have to have the bandage, but before this issue becomes a crisis again we need a serious discussion about a meaningful and realistic fix. We have two new contenders for that big white house on Pennsylvania Avenue, and we need to ask them what they think about it, and what they plan to do to fix it. If we don't, its like the old gospel song says, "Ain't nobody's fault but mine..."

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