Thank you. It's difficult to get your ear these days. You toil into the night, debating low sex and high crimes, who's flouting the rule of law, who's subverting the political process, whose mother wears combat boots.
And in the nanoseconds Washington has devoted to anything else, some of you have contemplated trimming projected Medicare payments to hospitals. This thought was planted in your busy but unproductive brains by a recent Medicare Payment Advisory Commission analysis (Dec. 21-28, 1998, p. 6), which said inpatient Medicare margins topped 16% in 1997-the highest level since prospective payment began in 1984.
The hospital industry objects vehemently to payment cuts, arguing that gross industrywide figures paint a skewed picture. Some hospitals struggle for financial life, the lobbyists say. But let's face it: Hospitals overall are faring nicely, thanks in part to Medicare's generosity. The industry fears you will turn off the magic Medicare money machine.
And you shouldn't, because of another report floating around the capital. The Urban Institute's National Survey of American Families shows that 12% of all children and 37% of low-income adults lack health insurance (Feb. 1, p. 17). Another recent study estimated that 16% of the nation's population is uninsured.
Much of that problem can be laid at your marbled doorsteps. In the past three decades, you have approved no significant expansion of health coverage. Even much-vaunted efforts such as the Kassebaum-Kennedy bill-which forbids insurers from denying coverage to those previously uninsured who have pre-existing medical conditions-were just tinkering. And while you tinkered, hospitals had to cope with the uninsured flocking to their emergency rooms.
Meanwhile, you shrank from hard decisions and failed to organize the nation's healthcare crazy quilt into a rational system. That left the dirty work of allocating resources to managed-care companies and Milliman & Robertson. They squeezed hospitals with such gusto that Medicare is now one of the best payers around.
So when you are tempted to trim Medicare, remember the financial pain your inaction has caused. Consider the extra cash a modest compensation for hospitals' troubles. And do what you do best: nothing.