In late July and early August the political wrangling in Washington, DC was in overdrive. President Obama, Mitch McConnell, the Senate minority leader, and John Boehner, the Speaker of the House were engaged in an historic showdown over raising the debt ceiling. The compromise they ultimately agreed to, authorized raising the debt limit by $1.2 Trillion, enough to avoid having this same issue come up again until after the 2012 election. It also required both the House and Senate to vote on a Balanced Budget Amendment, something that hasn’t happened yet. But, the most controversial part of this “bipartisan accord” was the formation of what has been called the “Super Committee” to find $1.2 Trillion from within the Federal budget to offset the agreed to increase in our national debt

This unprecedented “Super Committee” is comprised of twelve members of Congress; six Senators and six members of the House of Representatives, evenly divided with six Republicans and six Democrats. The party leaders from each house subsequently appointed the actual members. Perhaps the most controversial aspect of this mini-Congress is the agreement, which was made in advance, requiring the recommendations of the committee to be brought to both the House and Senate for an up or down vote without the possibility of any amendments. If the committee’s recommendations are not passed by the entire Congress, a mandatory $1.2 Trillion cut in Federal spending will automatically take place with half the cuts coming from the Defense budget and half from the healthcare budget (Medicare and Medicaid).

Obviously, this “Super Committee” has been given a unique responsibility and incredible power. Whether this form of governance is allowed for under the Constitution is another question, but their deliberations are already well underway. The deadline for this process to be completed is November 23^rd, just one month from tomorrow. There has been much speculation as to what their recommendations will be, assuming these highly partisan politicians can come up with any cuts that a majority can agree to. The obvious and most logical approach would simply be to repeal the Patient Protection and Affordable Care Act of 2010 (Obamacare). It is the most recently enacted entitlement program and it has a price tag of at least $1 Trillion. For the most part Obamacare has not yet been implemented, so repealing it would not be removing any significant benefits that people have grown accustomed to, and the majority of Americans have opposed the law since long before Mrs. Pelosi told us “we need to pass it so we can find out what’s in it.” The House of Representatives has already passed a bill repealing the law shortly after the Mid-term elections when the GOP seized the majority, but the President and the Democrat majority in the Senate see this healthcare reform act as their landmark piece of Progressive legislation. They simply will not give it up as long as they are in control.

From a healthcare perspective Obamacare is not the only big issue in front of the “Super Committee.” For the last 13 years the Medicare payment system for physicians has been regulated by an incredibly arcane system ironically named the Sustainable Growth Rate Formula (SGR). It is neither sustainable nor growth promoting. (See The Future of Healthcare in America – May 27, 2011 http://www.spiritofhealthcare.com/?p=52) Under this formula Medicare payments to physicians are scheduled for a 29.5% across the board reduction on January 1, 2012. Every Medicare beneficiary would immediately feel the effects of such a draconian action by the government since many physicians would be forced to stop participating in the program all together. Even at current payment levels many physicians view Medicare as little more than a “break-even” proposition. If payments drop by 30% many will be forced to close their doors to Medicare patients, something that no one wants to see. Unless of course the real plan is to ration care.

To repeal the SGR and create an alternative physician payment system requires Congress to permanently wipeout the associated deficit, which has accumulated under the current system since 2002. That number is about $300 Billion. So for the Super Committee to include the SGR repeal in their recommendation would raise the total budget cuts required to $1.5 Trillion. (Isn’t it amazing how basic math has a way of eventually catching-up with you?)

A few months ago the Democrat party ran a television ad showing an elderly lady (gramma) in a wheelchair being thrown off a cliff, presumably by Representative Paul Ryan of Wisconsin. His budget proposal to rein-in spending and balance the budget would fundamentally change the Medicare program over the next decade. It is unclear whether Americans have the collective will to make any fundamental changes to our largest government program in order to save it, but one thing is perfectly clear. Given the likely inaction of the “Super Committee” and the vast philosophical differences within our current Federal government there appears to be little chance of avoiding the imminent collapse of Medicare. As bad as all this sounds, the economic and political turmoil we are currently experiencing trying to sustain the Medicare program will pale in comparison to what the next generation will have to deal with once all Americans come to realize we have purchased a European style healthcare system (Obamacare), with our once cherished individual freedoms.

The opinions expressed herein are my own and do not necessarily reflect or represent the policies or opinions of any medical organization or group.

Check out my web site at www.robertsewellmd.com