BEGIN TRANSCRIPT 
 
RUSH: Kathryn in Colleyville, Texas.  Great to have you on the EIB Network.  Hello.
 
CALLER:  Hello, Rush.  It's great to talk to you.
 
RUSH:  Thank you very much.
 
CALLER:  I was calling about Medicare and the slow erosion of freedom within the doctor community.  Basically over the past two or three months, cardiology has been taken incredible pay cuts, which are impacting the practice of medicine.
 
RUSH:  Medicare and Medicaid particularly, you mean, right?
 
CALLER:  Medicare, yes.
 
RUSH:  Yeah.
 
CALLER:  Specifically, a couple of months ago the imaging that is performed in cardiologists' office took a 40% pay cut, and that was followed up this past Monday with a 20% pay cut to all physicians.  It's really affecting how patients are getting taken care of.  We had to lay off some employees, and it's really touch and go whether we'll be able to continue to see Medicare patients.
 
RUSH:  I was just going to say: Your only hope is to get out of the program.
 
CALLER:  Well, there is an out, which a lot of cardiologists -- about, probably, 30% -- have already accepted. Hospitals are buying out cardiology practices, only to become employees of hospitals.
 
RUSH:  Yeah.  I know.
 
CALLER:  Huh. And that's (garbled).
 
RUSH:  But once you opt out of Medicare you can't take a Medicare patient ever again, right?
 
CALLER:  I'm not sure all the rules.  I'm probably out of my territory there, but there are specific rules for not taking care of Medicare patients. But the problem is that once you're an employee of a hospital you've lost your freedom, and some practices that have been bought out have already been told by the hospitals that, "Oh, well, we're going to have to cut your pay 15%, and you have no recourse."
 
RUSH:  All right.  I want to try to put what you've said here into an understandable context for the audience.
 
CALLER:  Thank you, Rush.
 
RUSH:  No, no, no.  Stay on the line here because I need you to tell me if I'm right or wrong on this.
 
CALLER:  Okay.
 
RUSH:  The odds are I'm right (I'm very seldom wrong) but I still want you there to correct me.  Now, the very people who just yesterday in a big dog and pony show said, "We're going to expand coverage, we're going to insure 31 million more people, we're going to lower costs," the same people are reducing what they are paying you and your husband, cardiologists, to the point that you cannot keep your practices going?
 
CALLER:  That's basically it. It's a huge part of this. Probably 50% of local cardiology business is Medicare.
 
RUSH:  Well, of course it is.
 
CALLER:  It's a very successful business. Let me tell you that over the past ten years... You know, heart disease was the number one killer ten years ago.  But do you know that in the last ten years the mortality has dropped 30% because of cardiology care?
 
RUSH:  Yeah. Oh, I'm not surprised.  Despite all these horrors like childhood obesity, the life expectancy just continues to edge upward in this country.
 
CALLER:  That's right.
 
RUSH:  But my point with you, Kathryn, is that the very people who claim they know how to fix this are breaking what we have now.
 
CALLER:  Exactly.  What we have now is already so broken that basically insurance companies and government have doctor groups fighting among ourselves for what's left of our 8% of the Medicare dollar.  About 8% of what goes through Medicare actually makes it to doctors.  Everything else is wasted.
 
RUSH:  Thank you, Kathryn.  I want to make another point about this, ladies and gentlemen.  I want to go back to my old buddy Howard Fineman and his piece earlier this week in Newsweek in which he wondered, "Where's all the money going?" Where's all the money going if they're cutting the doctors? Well, the money isn't there. We don't have it.  We have a $1.5 trillion deficit. The money is owed. The money is going to debt.  But this is the real point.  You listen to this doctor. I could do this all three hours any day I wanted.  I could take calls from doctor after doctor after doctor who would tell the same story:  Medicare payments, copayments are being cut back to the point that they can't continue to keep the office open on what the government is paying them. 
 
You have cardiology patients, heart patients, going in to get treated, and some far-off bureaucrat somewhere... Not an insurance company. We're talking Medicare here, not some evil insurance company. Some federal bureaucrat is deciding what the cardiologist is going to get paid.  That's not a free market.  There's no relationship to Kathryn's patients and the price of Kathryn's service.  The patient isn't paying diddly-squat, or very little on Medicare and even less on Medicaid if we lump that in.  We'll leave Medicaid out of it for now.  There's absolutely no relationship. These people walk in with a heart problem. The service and the fee attached to it by Kathryn and her husband the cardiologists is not based on that woman's ability to pay or the patient's ability to pay or the patient's level of care that's needed, treatment, what have you. 
 
Some bureaucrat that nobody knows, sitting far away in some dank federal office, is using a computer with printouts and models -- formulas and so forth -- to determine what the doctor rendering the service is going to be paid. This is price fixing. This is government control. We already have this.  This is why it's messed up.  Now, we can get lost in the details here of the doctor's only getting reimbursed this or they're having their payments bundled here or what have you. That's not the point.  The problem is, imagine if you had to check into a hotel this way and the room is 400 bucks a night, and some federal bureaucrat says, "We're only going to pay the hotel a hundred bucks for this," and the hotel has to give you the room!  It can't be sustained.