WASHINGTON, September 18, 2009 ( – The health care bill proposed by Senate Finance Committee Chairman Max Baucus on September 16 contains a dangerous provision that creates a financial incentive for Medicare doctors to deny treatments to seniors says the National Right to Life Committee (NRLC).

“This is the cruelest and most effective way to ensure that doctors are forced to ration care for their senior citizen patients,” said National Right to Life Executive Director, David N. O'Steen. “It takes the telltale fingerprints from the government: instead of bureaucrats directly specifying the treatment denials that will mean death and poorer health for older people, it compels individual doctors to do the dirty work. It is an outrageous way to provide coverage for the uninsured – by taking it away from America's senior citizens.”

The provision penalizing doctors establishes that for at least five years, Medicare physicians who authorize treatments for their patients that wind up in the top 10% of per capita cost for a year will lose 5% of their total Medicare reimbursements for that year. NRLC argues that this means that all doctors treating older people will constantly be driven to try to order the least expensive tests and treatments for fear that they will be caught in that top 10%.

It is noteworthy, says NRLC, that this feature operates independently of any considerations of quality, efficiency, or waste. If a physician authorizes enough treatment for their patients, however necessary and appropriate it may be, they are in danger of being one of the 1 in 10 doctors who will be penalized each year. Moreover, it creates a moving target – by definition, there will always be a top 10%, no matter how far down the total amount of money spent on Medicare is driven.

“It's like a game of musical chairs, in which there is always one chair less than the number of players – so no matter how fast the contestants run, someone will always be the loser when the music stops,” O'Steen added.

The incentive this creates is purely cost-driven, without any balancing of benefit, says NRLC. The groups argues that this will create a constant sense of uncertainty in doctors, since none can know in advance precisely what the cutoff for a given year will be – resulting in still more pressure to limit treatment and diagnostic tests to the bare minimum.


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