To: i-node who wrote (57148 ) 2/20/2018 8:19:54 AM From: puborectalis Respond to of 354885 President Trump has proposed some modest steps to slow the apparently inexorable growth in Medicare entitlement spending, breaking with his campaign promise to leave alone government-funded programs for seniors. Although there is often little correlation between presidential budget proposals and budgets eventually approved by Congress, the administration’s budget, which calls for reducing Medicare spending by about $270 billion over 10 years, may start the conversation about what to do to slow growth in Medicare spending. While cuts in provider payments in some areas will be significant, the administration has left alone the harder questions of whether we can afford to provide generous Medicare benefits to all seniors and to continue to make coverage decisions largely without considering cost. Payments to doctors and hospitals While Medicare provides about $672 billion in annual benefits to 55 million Americans 65 and older or with disabilities, it is misleading to imply that the proposed changes are guaranteed to leave coverage or benefits unaffected; there has to be a limit to the “cut reimbursement growth and hope for the best” strategy that goes back to the 2010 passage of the Affordable Care Act (where subsidies to the uninsured were largely financed by Medicare cuts). Most of the proposed savings from reducing Medicare-related hospital and physician payments come from decreasing allowances for bad debt, uncompensated care, post-acute care, graduate medical education and by paying hospital-owned clinics no more than non-hospital owned clinics. These types of cuts may be described as not directly affecting Medicare beneficiaries, but directly or indirectly these cuts will have some impact as hospital margins erode. Physicians in training may need to accept lower stipends or see training programs eliminated, services for the remaining poor and uninsured may be curtailed, and some doctors with sufficient shares of privately insured patients may “go concierge” and turn away Medicare patients.