Before we get too mournful about the impending demise of the Medicare trust fund, we should remember that the fund is nothing but the figment of a congressional bookkeeper's imagination. All those Treasury bonds purchased with the excess of the Medicare tax collected above the mandated spending, which supposedly represent the fund, are freely borrowed for off-budget highway construction, defense spending, various subsidies, usually useless studies, etc. So the hard money really isn't there.
Cutting (reducing the increase below inflation) Medicare physician reimbursement is a de facto tax on physicians' income. Nobody else gets treated this way. Despite the work of American Medical Association lobbyists, physicians are at the bottom of the political food chain. Regardless, cutting physician reimbursement won't save Medicare.
What nobody seems willing to say is that the way to save Medicare is to increase the basic tax rate so that in 2001 or 2002, when Medicare spending becomes as great as the amount of tax collected, the increase in taxes will keep the Medicare budget balanced. It also will stop the surreptitious borrowing and force off-budget spending back into the visible budget instead of onto the deficit. But nobody really wants to bite the bullet. Talk is cheaper.
GEORGE MANNING, M.D.
Fort Wayne, Ind.