If your concern about the status of healthcare in this country only extends to the 2008 election, please turn to another part of this newspaper.

If your concern about the status of healthcare in this country is about solutions, then I invite you to read on, offer feedback and participate in what may be the most important, yet under-regarded problem we face today, and will face in the future.

No matter if you favor consumer directed healthcare, or a single payer government-run system, a commitment to finding workable solutions should be our pledge to the American people.

Currently Congress plays a role in about 50 percent of healthcare spending in this country. The other half is comprised of for-profit insurance, out-of-pocket expenses, and charitable or otherwise uncompensated care.

For those favoring a single payer system, a questionable ability of the government as proprietor certainly argues against an expanded role for this side of the equation. Simply stated, are our priorities correct? Every healthcare dollar controlled by government has the potential for further distortion of the marketplace, whether it is the unintended effects of price controls, unequal anti-trust laws or an overly burdensome regulatory environment.

In short, is the government a good steward that deserves an expanded role in our nation’s healthcare?

Regardless of where one comes down in the public/private debate, system-wide reform seems to be a common thread. And here it is critical to keep priorities in order.

About 18 months ago, just prior to his departure as chairman of the Federal Reserve board, Alan Greenspan was speaking to a small group on the Hill. He was asked about the future of Medicare, and his response was somewhat surprising. He was less concerned about the overall solvency of the program as he was about “having anyone there to provide the services required.”

Clearly workforce issues concerned the fed chief over a year ago, and nothing has happened in the interim to mitigate that concern. And it may have gotten worse.

As a leader in the nation’s capital, if you see an impending train wreck, what is the correct course of action? Try to wake the switchman to avert the disaster, or secure a video camera to record the carnage and try to be the first to post it on YouTube?

My approach as a physician leader has been to attempt to preserve and strengthen the physician workforce, so that patient access in the future is not in crisis. Regardless of who is in charge.

And within this approach are three principles, all of which are important in their own right. To state it simply, we need to help the workforce of today, while we prepare the physicians for tomorrow, and ensure that new doctors yet to come can see a future in medicine.

For the physicians of today, there is no more important task than to fix the programmed cuts to Medicare that are the most pernicious and pervasive obstacle to preserving the medical workforce. Let me state again for emphasis, there is no more important task ahead of this Congress if we want to ensure our Medicare patients can receive care.

A solution to the problem has evaded members of Congress of both parties for decades, but the answer is so simple that it sometimes gets lost. Stop the cuts. Fix the formula.

The impediment has been and remains the “cost” as constructed by CBO which runs into hundreds of billions of dollars, and more destructive, becomes larger every year it remains unsolved.

Restoring equity to the method that Medicare uses to pay doctors has become an annual rite here in Washington. Over the years, cuts to Medicare physician payments have been averted by creative legislating, and Congress will once again need to find a solution to halt a cut of 10 percent to the physician payment rate in 2008. In 2009, it only gets worse, as by doing so the window of opportunity in which we can actually reform the system only becomes smaller and smaller. The current payment system, in an attempt to control the volume growth of services by bad actors, punishes the good actors. The system doesn’t work for physicians, patients, public officials or the American taxpayer, yet we allow it to persist.

The first principle of sensible physician workforce reform will require Congress to immediately halt any cuts in Medicare physician reimbursement. Allowing these scheduled cuts to go into effect would create a chain reaction in the medical community and diminish the quantity and quality of healthcare available to all Americans and not just Medicare beneficiaries. Congress must also address this in a long-term nature or face future catastrophe because the problem only becomes more expensive if it is allowed to persist. Allowing this situation to smolder will result in fewer physicians accepting Medicare patients, reduced access for beneficiaries, and a constriction of the physician workforce pipeline over a period when demand for medical services is projected to explode. Fewer students will pursue medicine as a career. Even fewer will choose primary care fields within medicine. And all of this will happen while the baby-boom generation begins to grow older and faces more and more medical challenges.

The second and third principles will require Congress to make needed investments in medical students through loan and scholarship assistance as well as make important financial assistance available to smaller rural and suburban hospitals to kick-start new residency training programs. Today, I have introduced three pieces of legislation that attempt to address the issues facing the current physician workforce and the physician workforce of the future. We owe it to Americans to be proactive before this situation careens out of control. As my physician colleagues are ready to note, an ounce of prevention is worth a pound of cure.


Burgess is vice chairman of the Republican Policy Committee.