Opinion | Medicare Cuts Beg the Question: Do Doctors Know How to Make ‘Good Trouble’?

The Centers for Medicare & Medicaid Services recently announced a pay cut of 3.4% for physician fees in 2024.

In this video, healthcare marketing consultant Ron Harman King, JD, MS, discusses the announcement, how the changes are affecting both physicians and patients, and what physicians should be doing to bring their message to the masses.

Following is a transcript of his remarks:

Buried among the news of the holiday season is an announcement that the Centers for Medicare Services has settled on a pay cut of 3.4% for physician fees in 2024. The announcement has rightfully triggered an uproar from healthcare providers.

Sadly however, against the backdrop of wars in Ukraine and the Mideast, a presidential race, Donald Trump’s 91 indictments, and spiraling climate change, the news in contrast earned barely a handful of headlines. Moreover, news about a proposed 1.3% pay hike in 2025 got even less media coverage.

Because physicians earn the highest incomes of all occupations in the U.S., the American public usually treats news about doctor pay with a swipe-left in their smartphone news feeds. I can see why. Time and again, whenever a healthcare crisis erupts, the medical profession ends up talking to the wrong people.

If healthcare providers want to make this issue more than a tempest in a teapot, they’ve got to make the kind of good trouble that made the late Congressman John Lewis a civil rights icon. Otherwise, the Mark Twain adage starts to sound applicable: Everybody complains about the weather, but nobody does anything about it.

I say, if physicians want to do something about Medicare cuts, they should heed the classic advice given to journalists: To make somebody care about something, tell them how it will hit their pocketbook.

Texas cardiologist Rick W. Snyder II, MD, did an excellent job of just that in his November 20th MedPage Today opinion piece, “The Broken Medicare System is Forcing Physicians Out.” Dr. Snyder tells of physician colleagues in private practice barely getting by in the face of labor shortages and escalating operating expenses.

Further, Dr. Snyder cites American Medical Association [AMA] data demonstrating that since 2001, Medicare physician payments have lagged 26% behind inflation. Net effect, the reimbursement decline threatens to put docs under water and force early retirement and/or closure of practices.

Growing numbers of providers are reacting by refusing to accept Medicare patients. Layered on top is the reality that about one-quarter of American adults are on Medicare. And the number of Medicare-eligible Americans is projected to grow in just the next 6 years by approximately 7 million.

Coupled with this, the number of geriatricians trained to treat and care for the elderly are retiring faster than new doctors training to take their place.

Now, here comes the hitting-them-in-the-pocketbook part. Congress has recently raised the age for full Social Security benefits from 65 to 67. Some representatives have also explored raising it to age 70. Thus, Americans will have to work longer before they can afford retirement.

Added to the Social Security change is a shrinking pool of healthcare providers accepting patients without commercial healthcare insurance. This means Americans now have a double incentive to stay in the workforce longer in order to retain employer healthcare insurance benefits.

Those who do retire earlier will face a range of not-so-pleasant choices from buying pricey individual policies, to paying thousands of dollars monthly to concierge medical practices and praying for no health catastrophe, to going without insurance altogether and courting total disaster.

Call me crazy, but I’d say that if the aging Joe Shmoe fully grasped all this, he’d be really hotly emailing and calling his Washington representative and voting accordingly in the next election.

Yet, instead of attempting to open Joe’s eyes fully, in response to the Medicare pay cuts, the American Medical Association and nearly 120 national medical associations and state medical societies sent a letter to Congress. Fine. Terrific. Maybe someone important read the letter. Maybe not.

That’s the problem with letters. They don’t get much if any attention. The well-monied people are well represented by the U.S. healthcare lobby, which reportedly spends north of $700 million annually lobbying federal policymakers — with a large chunk going to the benefit of pharmaceutical and health product manufacturers.

Although the AMA is reportedly the nation’s third largest lobbyist organization, its lobbying budget makes up less than 10% of its total spending, or roughly 3% of all healthcare lobbying investments.

I know how to save the AMA a wad of cash. Pharma companies, a recently re-elected governor, and the nursing profession have shown the way.

Just weeks ago, voters in Kentucky gave Democratic governor, Andy Beshear a second term in a politically deep-red state, where the legislature passed a near-total abortion ban in 2022. Ronna McDaniel, chair of the Republican National Committee, said the tipping point for the victory was a 30-second TV ad in which a college student told of years of sexual abuse by her stepfather, starting at age 5.

The victim became pregnant at age 12 and subsequently miscarried into a toilet bowl at home. “To tell a 12-year-old girl she must have the baby of her stepfather is unthinkable,” she said in the ad, which was viewed 3 million times. Beshear, a pro-abortion-rights advocate, won the race by five percentage points.

Then there’s the nurses’ nationwide strike of 2023. In October, 75,000 nurses, pharmacists and other healthcare workers at Kaiser Permanente [KP] alone walked off the job over complaints of underpay, overwork, and inflated patient-to-nurse ratios.

The KP strike ended 3 days later with KP’s promise to address staffing shortages and a 21% raise for the strikers over the next 4 years.

Nevertheless, throughout the summer and fall it was all but impossible to watch a TV newscast without seeing images of the picket lines. Not coincidentally, it’s all but impossible to watch TV without enduring a slew of drug ads.

A half-century ago, pharma companies promoted their products directly to doctors. Then, in the 1980s, pill pushers began direct-to-consumer advertising. Within a decade, the industry was spending $10 billion a year on pharma ads, thanks in part to eased FDA restrictions.

Are you listening, AMA? Stop writing letters to politicians and start buying 30-second TV spots. Take your story to the streets. Tell Joe Shmoe about a pending Medicare cataclysm.

And doctors, you have high social status, as well as inspiring ideas on fixing the problem. I know. I read quite a few in the readers’ comments to Dr. Snyder’s MedPage Today essay.

Put your ideas into letters to newspaper editors. Get in front of cameras at your local news stations. Organize letter-writing campaigns demanding the AMA spend a fraction of its lobbying efforts on nationwide public-interest ads. Heck, organize Medicare sit-ins on the steps of the U.S. Capitol if you have to.

Yes, it takes time. But this is the kind of “good trouble” that John Lewis and his compatriots used to advance civil rights in this country. Healthcare is just as important. You’ve got the power, baby. Seize it. The nation needs you more than ever.

Ron Harman King, JD, MS, is CEO of Vanguard Communications, a healthcare marketing and practice management consulting firm, and the author of The Totally Wired Doctor: Social Media, the Internet & Marketing Technology for Medical Practices. He blogs for MedPage Today on the topics of technology, the law, and the patient experience.

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