Thursday's big foray in the world of trying to get Beltway pundits to maybe notice that the effects of the sequestration are actually real and kind of a big deal came from The Washington Post's Sarah Kliff, who reported that "Cancer clinics across the country have begun turning away thousands of Medicare patients, blaming the sequester budget cuts." The issue involves the intersection of the sequestration's cuts to Medicare and the expensive pharmaceuticals that oncologists use to treat their patients. Cancer clinics are increasingly finding themselves forced to make a Sophie's choice that one clinic executive describes as being "between seeing [Medicare] patients and staying in business.”
Kliff's article has not been sufficient to convince conservative talk-radio host Rush Limbaugh, however, who took to his microphone today to characterize Kliff's article as "manufactured and made up." But not long after taking issue with Kliff's story, Limbaugh got a call from a fan, who tried to set him straight.
Beginning with Kliff, here's what's at stake:
Oncologists say the reduced funding, which took effect for Medicare on April 1, makes it impossible to administer expensive chemotherapy drugs while staying afloat financially.
Patients at these clinics would need to seek treatment elsewhere, such as at hospitals that might not have the capacity to accommodate them.
“If we treated the patients receiving the most expensive drugs, we’d be out of business in six months to a year,” said Jeff Vacirca, chief executive of North Shore Hematology Oncology Associates in New York. “The drugs we’re going to lose money on we’re not going to administer right now.”
But Rush Limbuagh, man, he no likey:
RUSH: Okay, folks, this is classic. It is classic. If you haven't heard this, it is in The Washington Post, and the lead of the story is: "Cancer clinics are turning away thousands of Medicare patients. Blame the sequester." Oh, yeah. Yeah. Don't you see, it's the sequester. And that means it's the Republicans. The Republicans are the reason Medicare patients are being refused cancer treatment. Oh, yeah. It's not Obamacare. Of course not. It's not the fact that, what, Medicare was cut $714 billion in Obamacare. But it's the sequester. See, folks, it's not Obamacare. You cancer patients are being turned away from treatment because of the sequester, because of the Republicans.
So the way this works is Obama can cut $700 billion out of Medicare, that doesn't hurt a thing. That doesn't cause anything, certainly nothing bad. But the sequester, which does not touch Medicare, is now causing doctors to start turning away cancer patients.
If you need to return to memories of the 2012 election season kerfuffle over that $700 billion Medicare cut, for auld lang syne, knock yourself out. The more pressing point is that while legislators did what they could to spare Medicare from the sequestration's blade, everyone who successfully completed Sequester 101 knows that sequestration included "a 2 percent cut ... imposed on Medicare provider payments," effective April 1. What Kliff makes clear is that what everyone characterized as a slight cut is falling especially -- and perhaps unexpectedly -- hard on the providers who service cancer patients with chemotherapy drugs.
Limbaugh is under the impression that Kliff's description of this 2 percent cut is just false, and he seems to believe that he's backed up by the Associated Press -- he insisted on the air today, "As the AP says, legislators exempted Medicare and Medicaid from the sequester. There aren't any cuts in Medicare." -- but I'm not sure what he's talking about. Here's an Associated Press story that seems perfectly aware that "Hospitals, doctors and other Medicare providers are on the hook for a 2 percent cut under looming government spending reductions." But we don't actually have to take the AP's word for it, here (via a responding-to-Limbaugh Kliff) is the relevant portion of the legislation:
(8) IMPLEMENTING DIRECT SPENDING REDUCTIONS. -- On the date specified in paragraph (4) during each applicable year, OMB shall prepare and the President shall order a sequestration, effective upon issuance, of nonexempt direct spending to achieve the direct spending reduction calculated pursuant to paragraphs (5) and (6). When implementing the sequestration of direct spending pursuant to this paragraph, OMB shall follow the procedures specified in section 6 of the Statutory Pay-As-You-Go Act of 2010, the exemptions specified in section 255, and the special rules specified in section 256, except that the percentage reduction for the Medicare programs specified in section 256(d) shall not be more than 2 percent for a fiscal year.
At any rate, Limbaugh bottom-lined the matter by saying, "The Republicans had nothing to do with denying cancer patients treatment. The Republicans didn't do the sequester. It was a Barack Obama idea. The sequester does not feature any actual reductions in spending at all, and yet today the news is that Medicare patients cannot get cancer treatments because the sequester cut money authored by the Republicans, who do not want cancer patients to get treatment. That's the news of the day."
Obviously, there's really limited utility to the whole "the sequester was Obama's idea" argument at this point. After all, it's the GOP that is now budgeting from the standpoint that the sequestration's cuts are permanent and thus form the new spending baseline. The more interesting moment was what happened next on the air -- Limbaugh took a call from an oncologist, who tried to explain that he had this all wrong:
RUSH: Here's our oncologist in Dallas. Dale, I'm glad that you called. Welcome, I'm glad you held on. Welcome to the program, sir.
CALLER: Hi, Rush. You set me up with the story about the need to apologize, 'cause you screwed up in the Post story. There is really a cut in Medicare, and here's what it is. Medical oncologists who see and treat patients in their offices are allowed to charge for the pharmaceuticals which they purchase, a thing called ASP, which is average sales price, plus 6 percent, which lets 'em break even, when you figure the overhead of dealing with the patient. That's the Medicare situation.
RUSH: That's right.
CALLER: There's a 2 percent cut, and it's not 2 percent of 6 percent. The reimbursement goes down to 4 percent, plus ASP. And that means that they're actually absorbing a loss on each Medicare patient they treat.
At that point, Limbaugh contended that this was not what The Washington Post story described, that Kliff's specific point was that patients were facing, potentially, being turned away.
RUSH: Well, no, the story says you're turning them away. The story says you're refusing to treat them.
CALLER: Well, I can't tell you much about that one way or another. You gotta take care of the people.
RUSH: Well, the point of the story is that the doctors are turning cancer patients away and not giving them drugs, not treating them, because of the sequester.
CALLER: Some may. As it happens the organization that I'm familiar with is not, as far as I know, doing that. But here's the deal. Medical oncologists in community practice in many parts of the country have had to close their offices because they can't do business giving away more than they're taking in.
RUSH: Well, but that happened before the sequester. That's just part of Obamacare.
CALLER: Yeah, but this hit, which reduces their Medicare margin by one-third --
CALLER: -- Is not acceptable to them and some of them, I suppose, are saying, hey, you're gonna have to go somewhere else to get your care.
Limbaugh then reads from the article and asks the oncologlist to confirm whether its contentions were accurate. The oncologist does so, saying, "The 6 percent overhead is being reduced to 4 percent by the cuts that the government instituted. Oncologists are very upset about that." From there, Limbaugh shifts to a discussion over who is to blame:
RUSH: Doctor, who reduced the margin? Who picked this 2 percent --
CALLER: CMS [Centers for Medicare and Medicaid Services] sets that. And it's funny --
RUSH: Who is CMS? CMS sets that.
CALLER: Well, actually that's the division of the Department of Health and Human Services that oversees Medicare.
RUSH: Right, okay. So the government's doing this.
RUSH: All right, well, they're laying it off on you in the story.
CALLER: Of course. Why would they want to take the blame when they can get away -- it's like you said, do it and then apologize profusely.
I think that if the oncologist goes ahead and reads Kliff's piece, he'll see that Limbaugh is wrong when he claims it "lays it off" on the providers. Kliff's not trying to make these providers look as if they're being cruel of their own choice. The providers from her piece are caught in a cruel circumstance that wasn't discussed much in the months before this cut kicked in and these oncological clinics found themselves facing this dilemma. Kliff also does not single out either political party for blame at any point during her article. "Blame the sequester" itself, she says.
But this forms the basis of Limbaugh's brief:
RUSH: You and I really don't disagree in what's happening here. The government's laying all of this off on you, and when I say the government, in addition to trying to make it look like the Republicans are responsible for this because it's the Republicans that did the sequester, when they didn't. The sequester really doesn't have any real cuts from a baseline.
CALLER: It does in that one sense, and that's why I picked up the phone and called you because there really is a reduction. I'm in touch with my colleagues who tell me that this is a source of great concern for them because they're already closely hauled under margin.
It's important to point out that the caller, in terms of political allegiances, remained amenable to Limbaugh's point of view, and without having evidently read the article himself, was content to agree to characterize The Washington Post's efforts to inform as having a partisan slant. (Again, if he takes the chance to read the piece, he's going to see that Limbaugh was badly mischaracterizing Kliff's content and intent.) But through it all, he did maintain that Limbaugh was wrong to contend that the cuts were a fantasy, dreamed up by Kliff.
The oncologist also dispensed a little private-sector real-keeping:
RUSH: What's to prevent you from setting up your own private practice with cash-paying patients, you don't even mess with all this?
CALLER: I don't think they -- you know, Rush, some of these drugs are really expensive, and I don't think a cash-paying patient is gonna be able to ante up 18 grand for a single treatment of certain of the newer, really, really sophisticated anti-cancer drugs. It just won't work.
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