Health care issues: How to pay doctors under Medicare

Health care issues: Medicare payments to doctors

A look at key issues in the health care debate:

THE ISSUE: Should health care legislation include a so-called “doc fix” — funding to adjust Medicare reimbursements for doctors so that they don’t face annual pay cuts?

THE POLITICS: Democrats in the House and President Barack Obama have said they want health care legislation to include $245 billion to adjust Medicare payments for physicians. The money would ensure doctors’ pay isn’t cut, and solve a payment problem that Congress has fixed piecemeal for years. Critics say the payment is a budget buster and little more than a lucrative carrot designed to ensure doctors’ support of health care overhaul. Skeptics also say the administration won’t be able to reserve $245 billion for doctors and still meet Obama’s goal of crafting a bill that doesn’t add to the federal budget deficit.

WHAT IT MEANS: The “doc fix” could permanently remedy a problem that Congress has grappled with since 1997. Currently, a complex formula is used to set annual target prices for physicians services under Medicare. But that formula has not kept pace with actual costs. That’s led Congress, sometimes on a year-by-year basis, to allocate more money to doctors. But the “doc fix” would undoubtedly increase the federal deficit and, critics say, dramatically increase the price tag of already costly legislation.

— Henry C. Jackson