Health Care USA 2009

Washington is caught up in another one of its health-care spending burlesques, and liberals are belting out their favorite tunes. The GOP wants to "wipe out Medicare as we know it," sings Harry Reid. "The Bush Administration is perfectly happy to have billions of dollars going to insurance companies instead of Medicare beneficiaries," croons Pete Stark.

Republicans should be flogging themselves - for falling into this political trap. Doubly so because the theatrics are a preview of the health-care market if Democrats control both Congress and the White House. If John McCain needs another health-care red alert, here it is.

Every few months, Congress has a fire drill to prevent automatic cuts in the reimbursement fees that doctors receive for treating Medicare patients. The cuts - 10.6% this time around - have been scheduled for years, but Congress has made a habit of buying time with temporary fixes. The last one was in December; this one passed the House 355 to 59.

But it stalled in the Senate, by a single vote. Republicans are justifiably irked because the bill clips funds for Medicare Advantage, which lets seniors use federal dollars to buy private health coverage. Liberals despise Advantage, even though - or perhaps because - more than one out five of the 44 million people on Medicare have joined up. Tying a $13.6 billion rollback to the must-pass doctor bill was the Democrats' way of kicking off the post-2008 party a little early. In an Obama Administration, Advantage is dead.

The gloomy outlook is another squandered opportunity of the Tom DeLay era. In 2003, the universal Medicare prescription drug benefit handed the GOP a moment of maximum political leverage for free-market reform. Instead, the majority settled for the largest entitlement expansion since the Great Society, while their long-range market experiments like Medicare Advantage were bound to come under assault once Democrats were back in power. Sure enough...

The Clinton Administration sabotaged Advantage's predecessor, Medicare+Choice, by starving it of money. The playbook is the same now, though their task is more urgent because Advantage's impressive growth is seeding a deeper private market. It might even be convincing people that competition and transparency can work in government health care - especially compared with decrepit fee-for-service Medicare. Since private insurers must vie for consumers on quality and price, the benefits are more generous, usually including preventative care.

Those are the same services that Barack Obama says are the best way to control soaring health-care costs. Ironically, Democrats think the best way to kill Advantage is by cutting the subsidies that make those benefits possible. Insurers receive about 12% more per patient than traditional Medicare. Never mind that these subsidies were designed by Congress so plans could spread into rural areas and are being phased out over time. Democrats usually favor taxpayer health subsidies, but it seems some are more equal than others.

And that's 12% "more" compared to an utterly arbitrary baseline. As a virtual monopoly, Medicare uses a complex formula to set reimbursement rates for thousands of services. In short, it controls prices. That's why doctors are supposed to eat a pay cut, even though everyone knows this would prompt more doctors to stop seeing Medicare patients. But price fixing is the way that an open-ended entitlement like Medicare - which gobbled up $432 billion in 2007 - tries to control spending.

Not that it's working. The Medicare Trustees, in their latest futile report, note that the program now has an unfunded liability of some $36 trillion over the next 75 years, give or take a few trillion. As a percentage of GDP, expenditures are projected to increase from 3.2% in 2007 to 10.8% by 2082. Sooner or later, this trend will collide with reality, and a better way to rationalize Medicare is to convert it into a premium-support program like Advantage.

Yet Mr. Obama wants to go in the other direction and create a Medicare-like "public option" for everyone of any age. Democrats will fund this program generously, crowding out private coverage and maintaining the slow-roll toward a complete government takeover. Call it Medicare Advantage in reverse.

The fight over doctor fees is merely an appetizer for such a system, where competing interest groups would clash for their share of the spending pie. Highly politicized Medicare-like price controls on providers and services would spread to every health decision. The result would be rationing and declines in quality of care.

The GOP is losing the Advantage fight because Democrats are pitting physicians against the insurance industry, which is about as popular as Big Oil. The Bush Administration has imposed a regulatory freeze that will give Congress three days to work out a new reprieve for doctors when it returns from recess today. But the fuse will still be burning - and Republicans will continue to lose if they don't get behind a reform alternative.

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Pop off, Popov

Australia: Answers wanted on suspect surgeon and lazy medical regulators

A patient whose surgery was allegedly botched by a doctor accused of a string of negligent operations has demanded to know why he was allowed to continue to practise. The woman said the operation by Ivan Lubenov Popov turned into her "worst nightmare".

The doctor has recently been referred by the Medical Board of Queensland to the Health Practitioners Tribunal over alleged professional negligence regarding surgery and medical procedures on seven women over 10 months. The obstetrician and gynaecologist, who worked at Caboolture Hospital and is believed to have moved to South Africa, is alleged to have lied to patients and misled staff about his procedures to cover up surgical mistakes and potentially illegal operations between July 2006 and May 2007.

One woman had an ovary removed by Dr Popov, who allegedly lied to her about the reason for the procedure. Another alleged victim, who asked not to be named because of possible legal action, demanded to know who was watching over Dr Popov when he was supposed to be watching over her. "I am devastated and disappointed with myself that I really didn't do anything earlier, but I was just too traumatised," the woman said. "It has taken me such a long time to recover. I still experience pain. "For a surgery that should have been a safe and pretty much problem- free surgery, it really did turn into my worst nightmare."

She said she felt betrayed and questioned Queensland's Health culpability. "I wonder why surgery was allowed to go ahead with me. Wasn't there someone that was senior to him, who would have checked my history?" she said. "Was it really just up to him - just one person? And that is scary if that is the case."

Queensland Health said in a statement that Dr Popov was referred to the Ethical Standards Unit in 2007. "Dr Popov resigned before Queensland Health's action was finalised," it said. Dr Popov left the hospital last July but did not resign until six weeks ago. "The Health Practitioners Tribunal will determine whether the significant adverse medical events which occurred were the result of inappropriate clinical practice or by circumstance beyond the doctor's control," the statement said.

Restrictions on Dr Popov were only imposed by the Medical Board of Queensland last month -- after he resigned and other investigations were completed. A tribunal date is yet to be set to hear Dr Popov's case.

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