Granny, watch your back! Again! Just like the House bill, the Senate healthcare bill aims to cut costs off that back of yours–by cutting Medicare reimbursements for old folks.

Here’s a key feature of Sen. Max Baucus’s bill, written up on the MinnCom blog and spotted by Dr. Wes (the blog name of cardiologist Wesley Fisher):

If enacted, [the measure] would represent the most significant change to the Medicare payment model since the government-run program went into effect in 1966.

Medicare, which covers those age 65 and older, currently uses a fee-for-service model. The result is that states that provide fewer health care services — such as Minnesota, Wisconsin, North Dakota, Washington and Oregon — receive less money. At the same time, states that provide a greater volume of services — such as Florida, New York, California and Texas — receive reimbursements that can be more than double those paid to other states.


The measure gives the secretary of Health and Human Services, working with the Centers for Medicare and Medicaid Services, the power to develop quality measurements and a payment structure that would be based on quality of care relative to the cost of care.


“The change included today will help control costs and get the most from our health care dollars. This will strengthen the strong safety net of Medicare by ensuring funds are there to pay for our seniors’ health care,” [Minnesota Democratic Sen. Amy] Klobuchar said in a statement.

As Dr. Wes points out, “quality” means cheap, one-size-fits-all treatment (note the words I have bolded above), no matter what the individidual patient’s needs may be, as assessed by the patient’s physician based on his or her own diagnostic experience and the patient’s medical history.

Dr. Wes writes:

Medicare has historically withheld payments to physicians unless they performed lock-step “quality measures” before granting release of the remainder of 1.5 percent of the doctors’ payments that were billed. Needless to say, this model has been an abysmal failure (subscription) at improving the “quality” of care delivered and has been very expensive to implement. Further, others have noted the challenge of measuring quality on the basis of clinical outcomes.

But this has not dissuaded our legislators from forcing the “quality issue.”

And who would decide what treatments would qualify for the “quality” label so that they could be forced on doctors in a conveyor-belt system of treating the elderly? Why, the lucky employees of a massive new government bureaucracy to be called the C.M.S. Innovations Center! Here’s how one thrilled physician described the bloated new panel in the Baucus bill to the New York Times:

It would be funded with $10 billion over the next several years to implement pilot projects and demonstrations to promote new payment reform opportunities. There are quite a few problems with the bill, but this provision is truly visionary. The House legislation, HR 3200, mentions payment reform, but it [provides] only modest funding of $275 million. That’s not enough.

Bottom line: $10 billion for bureaucrats, to be taken out of your hide, Grams.

Furthermore, what “payment reform” really means is flat fees per patient instead of the fee-for-service model on whch most physicians have operated since the days of Hippocrates. Flat fees are, of course, a strong incentive for doctors to provide the stingiest care possible.

As Dr. Wes writes:

Perhaps I’m too cynical, but I think the subliminal message coming from Washington so far is really this: doctors should be happy becoming salaried employees of larger health systems. This way, the government can pay the health system a bundled fee and the doctors can fight for their share of the kitty.

So far, this seems to be how the government will envision “quality” at an affordable price in the years to come.

I just wonder how many doctors will stick around to find out.

Oh, that’s another little sacrifice you’re going to have to make, Granny: Not only less medical care but fewer physicians willing to treat you.