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    Congress continues down the yellow brick fantasy road with MACRA

    Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Ken Fisher, MD, who is an internist/nephrologist in Kalamazoo, Michigan, a teacher, author ("Understanding Healthcare: A Historical Perpsective") and co-founder of Michigan Chapter Free Market Medicine Association. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.


    Dr. FisherWhile Medicare and Medicaid are bankrupting federal and state governments because of deep structural flaws, our Congress refuses to address these flaws and to learn from its past mistakes. 


    Related: MACRA won't kill private practice says CMS' Slavitt


    Medicare and Medicaid have problems that far exceed those of social security.  Although besieged by demographic issues, social security pays out a fixed amount per person according to a known formula. Medicare and Medicaid, on the other hand, have no fixed payouts and can reach phenomenal amounts. 

    Additionally, as medical advances occur, especially those extending lifespan, costs continue to soar. Also, each recipient has no personal advantage in conserving resources, but rather is spending everybody else’s monies. 

    Because each individual’s taxes into Medicare are not deposited into an individual’s account, but rather spent immediately, these funds do not grow over time. These factors result in each Medicare recipient spending about three times more during a lifetime than was contributed during working years.

    In 2015, Congress passed the Medicare Access and Chip Reauthorization Act (MACRA) ending the totally failed SGR, but based it on a fantasy. The fantasy being that through computer information, rather than the individual involved, Congress will assess the quality of care delivered to Medicare and Medicaid patients, and thus, will pay for quality rather than volume. 


    Further reading: Top risks for doctors under MACRA


    Medicine is perhaps the most individualistic effort in any society. What may be appropriate for some patients depending on comorbidities and other factors may be completely inappropriate for others. Instead of patients making the decision that makes sense for them at a particular time in their lives with a trusted physician, Congress via computer algorithms will make that decision and make artificial payments accordingly.  It appears Congress does not understand the magnitude of the task they are seeking to accomplish. 

    Next: How do we fix this vexing problem?

    Ken Fisher, MD
    Kenneth A. Fisher, M.D. Nephrologist, and author, latest book, Understanding Healthcare: A Historical Perspective", available ...


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