COMMENTARY

Kicking the Can

Allan M. Block, MD

August 31, 2022

Medicare, like any other business (regardless of how you want to view it, it's as much a business as any other insurance company), is dependent on cash flow. Money comes in from young people and their employers through withholding and taxes, and goes back out again in payments to doctors, hospitals, and all the others who bill Medicare for services and supplies in providing health care.

Dr Allan Block

Unlike other businesses, it's hampered by regulations and competing interests that affect its viability and capacity to adapt to changing markets and circumstances.

For a while, estimates were that Medicare would run out of cash in 2026, but with a stronger-then-expected COVID recovery, it's been pushed back all the way to ... 2028.

Yeah.

The trouble here is that nobody wants to fix the system to keep it from happening. It's easier to blame the other side for losing the game than it is to work together to win it. This isn't a Republican or Democrat issue. Both of them are the problem.

Since Medicare started, the changes in American lifespan, population dynamics, and medical costs have meant that, as years go by, the spending on health care would eventually outstrip the cash coming in. Pushing it back 2 years doesn't keep it from happening, though it does give more time to find a solution. But that's only if you have people willing to do so.

Currently politicians favor a strategy of kicking the can down the road for the next congress to deal with. But we're running out of road to kick it down, and the odds of the next generation of politicians being reasonable, functioning, adults seem to get lower each year.

Can you run your practice like that? In such a way that you know that in a few years your expenses will outweigh your income? And just figure that at some point you'll get it figured out before your creditors come knocking?

Me neither.

If you were like me, or any other small business owner, you'd sit down and figure out what changes are needed so you'll still have a viable business down the road.

Of course, that's part of the issue. The people making these decisions for Medicare don't have a vested interest in it. If it fails, they have other jobs and income sources to move on to, not to mention some pension-funded health insurance plan. It's not their problem.

But for the patients, doctors, and other health care professionals who will be depending on it in 6 years, it is a problem, and a serious one.

Hopefully someone will listen before then.

Block has a solo neurology practice in Scottsdale, Ariz.

This article originally appeared on MDedge.com, part of the Medscape Professional Network.

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