As I imagine every practicing physician is aware and many of the public, we’ve been laboring for a few years under the shadow of the government’s persistent, impotent attempt to implement a program called the Sustainable Growth Rate, or SGR. It’s a form of water-boarding for physicians whose practices are dominated by Medicare-insured patients, an attempt to delay the inevitable insolvency of an unsustainable system by threatening Draconian cuts in reimbursement of an additional 20%, then, at the last minute, kicking the can down the road for a few months, only to reissue the threat anew. It’s a lot like Edgar Allen Poe’s slowly descending pendulum blade, reset just inches from the chest, but which never stops swinging … swinging.

Of course, the politicians realize there are consequences to actions, and even desperate physicians can’t absorb a huge cut with fixed overhead and expect to remain financially viable, so it’s anticipated large numbers will abandon Medicare if or when this comes to pass. Those nearing retirement may simply accelerate their plans. Others may seek refuge in salaried arrangements with hospitals (a cynic might think that this is the hidden agenda of SGR). Last week a bill to allow hospitals to hire physicians, SB 726, was defeated, but the issue is likely to rise again from the ashes like a political phoenix.

In any case, the issue of SGR won’t be addressed again until the end of the year, after the elections. No, it’s just a coincidence—stop being such a cynic; it’s unbecoming.


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