For months, physicians have been refusing to take new Medicare patients, and some are now even dropping long-time patients. The problem: Congress’s inability to resolve a now 13-year-long argument over how much Medicare should pay docs.

The whole mess started in 1997, when the government concluded that Medicare was overpaying many doctors. The reality was that some physicians probably were being paid too much while others were not being paid enough. For instance, the numbers of board-certified geriatricians have been shrinking for years–a clear sign that (among other things) their compensation is too low.

To try to fix this, the government first adopted a new physician payment system that would have begun reducing Medicare reimbursements over several years. That set off a predictable firestorm, but rather than wade through the politically explosive issues of rationalizing Medicare payments, Congress simply delayed the pay cut–year after year. Now, these cumulative reductions amount to a staggering 21.3 percent. In other words, Medicare docs are about to get hit with an immediate 20 percent+ pay cut.

This is, of course, impossible. But once again, instead of addressing the issue (Congress seems to have missed this despite passing the biggest health reform in a half-century), lawmakers again temporarily delayed the pay cut. Three times this year, they passed short-term delays. But the last one ran out on June 1 and the Senate went off on holiday before extending the doc fix for a few more months. 

Already stressed by health reform, physicians seem to have reached the end of their collective rope. For years, many have been threatening to stop taking Medicare patients but no-one took them very seriously. Now, many seem to be doing it.

I have not seen any hard data, but I am hearing a lot of anecdotes. One 80-something told me the following story: His wife needed a new primary care doc and tried to move to his physician. But the doc told my friend’s wife that she was not taking any new Medicare patients. My friend complained, and the doctor dropped him too.   

This is probably extreme, and many doctors say they have an ethical obligation to continue to treat long-time patients. But the economics of health care, irrational in the best of times, is now beginning to hurt real people.

The government needs to fix the Medicare payment system–not patch it, not duck the issue for a few more months–but fix it in fundamental ways. Its failure to address this as part of health reform was a scandal. But, despite the profound wishes of many in Washington, the issue is not going away.