Chicken – noun – A game in which the first person to lose nerve and withdraw from a dangerous situation is the loser.

This definition is wrong.  As of June 18, 2010, the definition is as follows:

Chicken – noun – A game in which members of congress put Americans in a dangerous situation, with the healthcare system being the loser.

In my lament about losing my Medicare population if the  21% cut went through, Maggie Mahar commented on my post:

Please don\’t worry about the 21% cut. This is something that the AMA and conservatives use to fear-monger– it will never happen.

It is a very crude solution to health care costs–even our Congressmen understand this. That is why they never implement it.

On the other hand, moderates are afraid of upsetting conservative voters by killing it. So they just keep postponing it. And then conservatives use the fear of it to advance their agenda with doctors.

But it won\’t happen.

Well, the government is, at this moment, cutting checks for service I rendered earlier this month that are 21% smaller than in the past.  Despite the fact that the senate passed a bill not only putting off the 21% cut, but actually raising the pay of doctors, the house is not happy with it.

WASHINGTON — The top House Democrat says her chamber won\’t vote on Senate legislation to reverse a cut in Medicare payments to doctors.

House Speaker Nancy Pelosi says the bill — it would reverse a 21 percent cut on Medicare doctor fees that was imposed on Friday — has to include elements of the Democrats\’ jobs agenda.

The move by the California Democrat appears aimed at pressuring the Senate to break a logjam on long-sought legislation to extend unemployment benefits and give money to states to help them avoid additional layoffs and furloughs. That bill is stuck on the Senate floor because of a GOP filibuster.

The Senate passed the doctor fee fix as a stand-alone measure on Friday after a GOP filibuster killed the bigger jobs-related measure the night before. The measure would only forestall the cuts — they are required under a 1990s budget-cutting law that Congress has routinely waived — for six months.  (Associated Press)

So as of now, I am being paid 79% of the already low Medicare reimbursement.  I hope Maggie Mahar is right about this being simple political posturing, but pardon me if my trust of politicians acting rationally is a bit weak.  It\’s a great big game of chicken.

  • The house is playing chicken with the senate.
  • The Democrats are playing chicken with the Republicans.
  • They aren\’t in the cars themselves, we are.  Doctors and patients are careening toward destruction in the name of political gamesmanship.

Surely they will flinch.  Surely someone will understand the consequences of the crash.  But you know what?  Sometimes each side expects the others will be the ones who flinch.  Sometimes nobody flinches.  Sometimes the cars crash and people are killed.

The longer the 21% cut is allowed to exist, the less shocking it will seem.  The checks are being cut, and the world hasn\’t ended yet, right?  Patients are still getting care.  Doctors are still earning an income.  People will adjust.


The only thing that is preventing absolute chaos in the system is the fact that nobody thinks politicians could really be this stupid.  But is that really true?  Who will take the political fallout if the 21% cut stands?  The Democrats in the house for not passing the senate bill?  The Senate Republicans who are filibustering the bill the house would accept?  Each side can demonize the other, and each side is insulated by that fact.  Maybe the politicians see the implosion of the system as an opportunity to bury their opposition in the fallout.

But we are in the cars, people.  We are the \”casualties\” that they will posture about: doctors who lose income, patients who lose doctors.  It will happen.  The longer the 21% cut is in place, the more solid this insanity seems, the more physicians – especially primary care doctors – will simply close their doors to Medicare patients.  We can\’t \”get used to\” losing money by seeing people.  It is already happening, and it will gain momentum as this madness continues.

Medicare is fragile, and this cut is a sledgehammer.  It\’s not evil Democrats.  It\’s not stupid Republicans.  Conservatives and Liberals are both acting irresponsible.  They\’re all betraying the trust we gave them.

Trusting congress is more and more feeling like being asked to trust and abusive spouse.  We want to think the best of these people who claimed they meant to take care of us.  We want to think that they understand what damage they are doing.  But sometimes insanity grips people and they stop looking at any needs but their own.  They betray their vows.

Even if this disaster is averted, staying in Medicare feels more and more like we are enabling the pathological behavior of our \”representatives.\”  If they don\’t pay the political price for destroying healthcare for their own political gain, we all lose.  The gamesmanship will continue and the stakes will get higher.  I am just getting tired of being a pawn in the game.  Averting this disaster will only embolden congress to go further in this game of chicken.

If things don\’t really change, the cars will really crash.  That\’s when we all feel the sudden shock when our car meets the other at 100 miles per hour.

Then there is just wreckage.

It\’s not a game.

People will die.


5 thoughts on “Chicken”

  1. They've been playing the same game of chicken since 2002.(The first year that GDP growth was so low that the SGR formula actually called for cuts in docotrs' fees.)

    They've been kicking the can down the road postponing the cuts every since.

    It is incredibly frustrating–especially the fact that they are screwing up your cash flow. I understand how that can make you uneasy.

    But you have to remember: they have done this before (sent you checks that reflected a cut becuase they had missed a deadline to postpone it) –and they always sent you the
    money they owed you some weeks later.

    That will happen again. I realize doctors are losing patience. But you have to remember they always do postpone the cuts again and send the money.

    Pelosi may wind up getting a much longer postponement. I certainly hope so.

    AS far as I can tell, she just doesn't have the votes to repeal the SGR. As we have seen, the conservatives are very, very stubborn.

    There really is nothing the president can do. He has said, from the beginning that the SGR formula should be scrapped. White House budget director Orszag agreed with him, MedPAC agrees with him.

    But the conservatives don't care what the president has to say. For them, this is an opporutntiy to fear-monger around the issue of health reform–upsetting doctors and patients.

    I'm sorry to say that this has little to do with doctors. It's all about politics.

    Perhaps, once Berwick takes office as the head of Medicare and Medicaid he can fashion a new rule about payments to doctors and somehow or other get it through Congress (or find a way to go around Congress.)

    I certainly hope so.

    But do keep in mind: what can't happen won't.
    Congress is not gong to slash payment to docs, across the board, by 21 percent.

  2. I REALLY hope you are right – and I believe that since you have been observing this whole mess for longer than me and from a different angle, you are probably right. But at some point of time, doctors are going to get REALLY angry, and I think we are not far off from this. Once we all start dropping Medicare (which I do not depend on – I accept it because I think there is a duty as a doctor to care for those with the greatest need), the system will fall apart. No amount of reassurances to doctors will fix that.

    It's like me telling a patient that the spot on the chest x-ray is nothing to worry about. They may want to believe me and be reassured, but they can't stop worrying it may be cancer. I can tell them that I have seen this a hundred times and it always has been benign, but they may wonder “what if I am the first one who it's not.” I don't fault them for their worry, and don't get insulted if they want to see a specialist. In the same way, I am reassured by your statement, but can't help wondering that just because something has never happened in the past, why can't it happen now?

    I have not shut my doors to Medicare patients yet, but the longer the cuts stay in place, the higher the likelihood that I will – and I am more civic-minded than many of my colleagues. I can afford to get a little bit shafted by the government for the sake of the patients I care for. But I do have a limit, and congress needs to understand (both D and R's) that the pot is about to boil over and it's time to stop playing politics and start serving ALL Americans.

    Really. It is that serious in my neck of the woods. It may be a game that could be played safely in 2002, but it is not the same environment. The system is much closer to falling apart.

  3. unfortunately this is not just a medicare issue. If the cuts are allowed to stand, and I agree with you, the longer the postponement, the more those who aren't in medicine will think it is no big deal, other third party payors will follow suit. What better way to provide more to their stock holders.

    As a PT, I have been long considering a cash-based practice, being frustrated with the lack of negotiating with insurances over rates, getting .40 on the dollar if I am lucky by being an in network provider. I, too, hope this is posturing, but I am getting very tired of the posture both sides assume, to the detriment of patients in need.

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