It goes without saying that any effort as massive and complex as the one being undertaken by those in Washington is bound to have myriad effects– some of them desired and planned, others, many others in fact, that are less than desirable and quite unplanned. There is a vast hinterland though of effects that many would have (and did indeed) predict but most hoped like the dickens would just not happen. There is always wishful thinking in the world– we are guilty of it ourselves each and every day during patient care. But we realize that such thinking is just that: wishful. We never hang our hats on it– never accept our thinking as some rigorous process that will yield a result or an outcome. Sadly, such awareness is not the norm and it is certainly not in fashion among politicians. Take for example the inclusion of funding cuts to Medicare and the decision by both chambers of Congress not to address the planned 20.1% pay reduction to doctors effective today (this is called the SGR adjustment). It was argued by many people in many places that the combination of these two will by simply economics drive doctors away from Medicare patients. This effect would be rapid, and fierce. The chorus of Senators and Congresspeople who fought such simple logic with rhetoric would comprise a list too long for this post, and their song is not worthy of repeating regardless. Needless to say– lots of Wishful Thinking was going on in D.C. over the past few months. So, with the passage on Christmas Eve of the Senate version of Obamacare, we see the first cracks in the shaky edifice that is care for the elderly and infirm in the U.S. Bloomberg News is reporting that The Mayo Clinic, the very same clinic praised by President Barack Obama as a national model for efficient health care, will stop accepting Medicare patients as of today at one of its primary-care clinics in Arizona.

Their reasoning? They say that the Federal Government simply pays too little.

How bad is it you ask?

The Mayo organization had 3,700 staff physicians and scientists and treated 526,000 patients in 2008. It lost $840 million last year on Medicare, the government’s health program for the disabled and those 65 and older, Mayo spokeswoman Lynn Closway said.

That’s nearly a Billion Dollars. That’s not chump change. The article goes on to inform us that such payment discrepancies are the norm and well understood by Medicare itself:

Nationwide, doctors made about 20 percent less for treating Medicare patients than they did caring for privately insured patients in 2007, a payment gap that has remained stable during the last decade, according to a March report by the Medicare Payment Advisory Commission, a panel that advises Congress on Medicare issues. Congress last week postponed for two months a 21.5 percent cut in Medicare reimbursements for doctors.

Now, one would think that such an outcome, like the decision by Mayo to stop seeing Medicare patients, would be a shot across the proverbial bow and force a serious re-think before things get out of hand. Sadly, this is not the case. In fact, their is presently a mindset among academics especially those with a seat at the HCR table, that everytime a faultline appears in their grand design, their is some explanation for it that can also be subject to Government Fixin’ and thus have the problem solved. Take this little nugget:

Robert Berenson, a fellow at the Urban Institute’s Health Policy Center in Washington, D.C., said physicians’ claims of inadequate reimbursement are overstated. Rather, the program faces a lack of medical providers because not enough new doctors are becoming family doctors, internists and pediatricians who oversee patients’ primary care. “Some primary care doctors don’t have to see Medicare patients because there is an unlimited demand for their services,” Berenson said. When patients with private insurance can be treated at 50 percent to 100 percent higher fees, “then Medicare does indeed look like a poor payer,” he said.

Okay, so the problem is not that Medicare pays too little, its that other payers actually pay too much. And, its not that Medicare pays too little, its that because there are not enough primary care doctors out there, the demand for their services is sooo high that they can simply not take Medicare and make enough money. So, lets break this little nugget of non-sense down a bit:

1. If Primary Care doctors can make so much money, especially without Medicare, why then is their such a shortage of them? The prevailing wisdom from The Academics is that it is because they get paid so much less in comparison to specialists. Well, Mr. Berenson seems to be saying that that line is a load of piddle patter. Primary docs are in such demand that they are rolling in the dough and they can just laugh off Medicare and rake in the cash regardless. Gotcha.

2. If non-Medicare payers pay so well, why was Congress fixated on health insurance reform for the better part of 4 months while the HCR package was shaping up? In fact. one of the main complaints leveled at insurers was that they paid doctors in an unfair and poorly understood manner. Not that any of this matters– mind you, the fact that a 3rd party decides how much a doctor can charge and get paid for their services is so penetrated into common culture that no one even questions it any longer. What if your home owners insurance dictated how much the plumber can charge or the fence guy can charge after the big storm, or your car insurance carrier can dictate how much your body shop can charge to fix your quarter panel? But, we digress.

The points above of course are meant to show both the extent to which The Academic’s running this whole Grand Plan will go to in order to explain away the Consequences of the Great Plan as it unfolds AND also to show what a damn goofball Mr. Berenson (despite his cool title of Fellow) is.

SO, decisions have consequences. The ripple effect from Christmas Eve is still being felt…