Saying our Medicare system has problems is an understatement.  The program is headed towards a fiscal train wreck as our population ages.  Its flawed, bureaucratically-determined payments underpay for many vital medical services, overpay for others, contribute to costly inefficiencies and do nothing to encourage quality medical care.  Even worse, doctors in Wyoming and across the country are forced to limit the number of Medicare patients they see. In some cases, doctors have even stopped seeing Medicare patients. 

I believe our seniors deserve the highest quality medical care America has to offer.  In order to provide this to them, we need the participation of as many of our country’s physicians as possible.  As fundamental as this concept is, you wouldn't know it by looking at how Medicare pays doctors for the services they provide. On July 1st of this year, Medicare is cutting payments to physicians by 10 percent and by a total of 40 percent over the next decade.  Over the same time period, it is estimated that the cost of running a medical practice will increase by roughly 20 percent.

It is important to remember that physician practices are also businesses. The problem with all these cuts to physician payments is that a growing number of doctors will continue to decide it doesn’t make business sense to see Medicare patients. The grim reality is that additional payment cuts will have serious consequences for the 68,000 Medicare patients in Wyoming, where there are already too few primary care physicians.  Here if one doctor decides to stop seeing Medicare patients, seniors in an entire community could be left out in the cold.

If the 10 percent cuts weren’t damaging enough, Wyoming physicians face an additional 2.5 percent cut because of unfair Medicare policies that pay rural doctors less than their urban counterparts. I worked for years to equalize payments for urban and rural doctors, and in 2003 was finally successful.  However, this provision expires on July 1st unless extended by Congress.

Last week, I voted for the passage of legislation to stop the 10 percent cuts and to extend through 2009 the rural payment bonus for Wyoming doctors.  At the time I finished writing this column, the Senate only hours before had failed to garner the 60 votes necessary to pass this important legislation.  Congress has an obligation to the seniors of this country to put a stop to these cuts.  I urge my colleagues on the other side of the Capitol to act immediately to preserve access to vital medical services for seniors in Wyoming.

Congress also needs to take a long overdue look at the entire Medicare program. Currently the program miscalculates the cost incurred by a doctor to see a patient.  Congress has to stop dragging its feet and start working with the medical community to tackle our Medicare woes head on.  Physicians also need to be at the table to discuss not just what they are paid, but how a better use of taxpayer dollars can be achieved.

Unfortunately, our physician payment woes are only symptomatic of Medicare's larger problems. If we could successfully reform the physician payment system, it would be an ideal springboard to broader Medicare reform that will be necessary to preserve the program for today’s seniors and generations to come.  In order to do any of this, Congress must first realize the seriousness of the physician payment issue.  The only thing worse than if Medicare were to go bankrupt is having no one to provide medical services to our seniors.  If we don’t fix the physician payment system, this prospect is dangerously close to being a reality.