While the “March Madness” that resulted in the passage of the Patient Protection and Affordability Care Act of 2010 would lead you to believe that STAT change was needed in our health care system, the on-going delay in the “fix” to the SGR (sustainable growth rate) formula for Medicare invokes images of a long waiting list for a rationed medical procedure.

Medicare, the federal government’s health care insurance plan for the elderly and disabled established in 1965, is largely funded from payroll taxes and FICA, and supplemented with premiums paid by its beneficiaries. It is administered by the Department of Health and Human Services via the Centers for Medicare and Medicaid Services (CMS), and is the place to look to see how our government will administer a health care system.

Since 1998, the SGR has been a component of the formula used to calculate physician payments for providing services to Medicare patients. It is based on the GDP and not on actual health care practice costs (which have been rising faster than the GDP.) The SGR produced steep cuts in physician compensation for services to Medicare patients, in hopes that by paying individual physicians less, overall health care cost would decrease.

Unfortunately, this approach has failed.

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In Massachusetts, where 97% of us have health insurance by mandate since 2006, we have learned a few things about health care reform.

We have learned that universal coverage does not mean universal access to a doctor.  The Massachusetts Medical Society reports that there is a critical shortage of family physicians and severe shortage of internal medicine doctors.  Seven physician specialties are also operating in critical or severe physician labor markets.

A recent study by the Robert Wood Johnson Foundation showed that 75% of non-emergency ER visits occurred because a regular physician was not available after hours, and half of these visits occurred because a timely appointment was unavailable.  With more than half of all the doctors trained in Massachusetts leaving the state, citing the practice environment and low salary levels, and one out of every four currently practicing doctors considering a career change, it does not appear that access issues are going to improve soon.

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