The term in economics is hyperbolic discounting, the inability to act today on what affects the seemingly distant future. You can apply it to some patients and lawmakers.
Thank the New York Times for illuminating the concept. A feature this week on financial planning addressed the well-known phenomenon of the inability of some people to save now to build a nest egg for the future. People know it’s a smart strategy but their immediate needs and wants take precedence.
Cardiologists may explain to patients that behaviors such as smoking or excessive alcohol drinking or eating junk food may have serious consequences, sometimes near term and sometimes longer term. Some patients get it. Others may nod but they can’t or won’t project into the future and they continue these habits.
Congress poses another type of challenge. Physicians yet again were escorted to the precipice of repealing the sustainable growth rate (SGR) formula, which is scheduled to kick in when a patch passed last year expires April 1. If that were to happen, they would face a 21.1 percent cut in Medicare fees.
The House voted with an overwhelming majority on Thursday to eliminate the SGR and sent bipartisan legislation to the Senate. After a night of votes on amendments of substance and not, the Senate retreated to a familiar position: procrastination. They decided to adjourn without deciding the issue.
The Centers for Medicare & Medicaid Services (CMS) is expected to be able bridge the spring break when lawmakers abandon Washington. D.C. “They can handle a two-week gap here,” Senate Majority Leader Mitch McConnell, R-Ky., told Reuters. “We'll turn to it very quickly when we get back. I think there's every reason to believe it's going to pass the Senate by a very large majority.”
They will need to resist the temptation to put off today what affects tomorrow. The horizon for lawmakers is whatever time period exists between now and the next election. Does putting off a solution to the SGR cost them an election? For the past decade and more, it has not.
The drag that the SGR imposes on physicians, their medical societies and ultimately patients has been articulated over and over. Few disagree that the SGR needs to be repealed. They differ over funding the repeal. Negotiating a solution would be wise and responsible, but it requires what may seem like political risk now for a benefit in the future.
The Senate regroups in mid-April. Maybe this will be the year that they overcome hyperbolic discounting, starting with the SGR.
Candace Stuart
Editor, Cardiovascular Business