Congress is debating health care reform legislation with huge 10-year price tags attached: $800 billion, $900 billion, even $1 trillion. Meanwhile, lawmakers also are wrangling over a big, old debt — a sore point with doctors that has festered with partisan bickering for years.

Call it the “doctor fix.” On Nov. 19, a majority in the House voted for HR3061, a bill that would avert a 21 percent cut in the rates Medicare pays doctors. If present law isn’t changed, the rate cut will take effect on Jan. 1. Medicare pays for over 20 percent of all U.S. physician services — $96 billion last year. Small wonder that the American Medical Association is adamant that the cut be canceled. Moreover, Medicare generally pays doctors less than what they would charge private-pay patients for the same service.

On Oct. 21, the majority of U.S. senators voted against fixing the doctor payments. Republicans and some Democrats objected that the bill wasn’t “paid for.” It would have added $247 billion in deficit spending over the next 10 years.

The House-passed bill would add $210 billion in deficit spending.

How did Congress get to this point of proposing that current senior-citizen doctor bills be financed with long-term public debt?

Cost-control gimmick

The genesis of the problem is in a Medicare law passed more than a dozen years ago. One of the cost-control gimmicks in the bill was a limit on what Medicare would pay for physician services. When volume of services exceeded a certain level, payment rates were supposed to fall to avoid deficit spending. This was all done so that the total 10-year cost of that bill would suit some target that members of Congress set back them.

It didn’t work. The number of Americans covered by Medicare grows daily. More Medicare beneficiaries are living to be very old and need more doctor’s care.

So every year or so for the past several years, Congress put a Band-Aid on the problem. They’ve slapped together temporary fixes that added more and more of the cost of Medicare doctor services to the federal budget deficit. A couple of years ago, Sen. Max Baucus, D-Mont., proposed reducing rates Medicare pays private insurance companies to cover seniors in Medicare Advantage plans and using most of the savings for the doctor fix. But his Republican colleagues, along with insurance companies, strenuously opposed that plan. (Reductions in Medicare Advantage are proposed in this year’s overall health reform bills, too.)

A 21 percent reduction in rates isn’t fair, especially at a time when physicians are being prodded to adopt new quality technologies, such as electronic prescription writing and electronic patient records. Medicare enrollees deserve to have the best choice of doctors possible. A rate cut of that magnitude would certainly discourage many doctors from seeing Medicare patients or taking on new ones.

No alternative to taxes

So a doctor fix is needed, but not the same old add-to-the-deficit patch. This year, Congress should swallow the bitter pill and fund the doctors’ services they’ve already promised to provide to seniors and disabled adults. The funding in lieu of deficit must come from taxes. What taxes? Well, among various health care proposals this fall, we’ve heard plans to raise income taxes on high-income Americans, to tax various medical providers and devices, to tax “Cadillac” health insurance plans and to raise the Medicare payroll tax that supports hospital benefits (not doctor services). Any member of Congress who is serious about controlling deficit spending should pick a tax and get an estimate of what rate would be needed to raise $210 billion over the next 10 years.

We make no prediction on how this doctor rate fixation will end. But we challenge members of Congress to answer this question: If you can’t support a tax increase to pay for doctor services already promised to Medicare enrollees, how would you propose to pay this obligation?

For the record, Baucus voted for the failed Senate doctor payment bill (S1776) while Sen. Jon Tester, D-Mont., Sen. John Barrasso, R-Wyo., and Sen. Mike Enzi, R-Wyo., voted against it. Reps. Denny Rehberg of Montana and Cynthia Lummis of Wyoming joined all but one of their fellow Republicans in voting against the House bill.