Playground powerbrokers

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As a kid, you never wanted to tick off a certain smart-aleck guy from the neighborhood at game time. Not because he was a great player. The truth is he was only average in most sports. But because his parents had bucks and that meant he usually brought nice equipment to the game.

Anyone who has played driveway basketball with an overinflated, slick rubbery basketball can tell you what a joy it is to play with a leather ball instead. The pavement or asphalt is terrible for the life of the leather covering, but while it still has the relatively new feel to it, there is nothing better.

So what does this have to do with elder care? Well, the reason you never wanted to tick off the smart aleck with the primo equipment is you didn't want him to quit and head home in a huff.  With his basketball, football or whatever the plaything du jour was under his arm, of course.

Now, it seems, we could be facing a healthcare scenario where some big kids are threatening to take their ball and go home if they don't get their way. It's come to this point before with physicians and their taxpayer-supported reimbursements, and they win every time. Ever hear of a community's nursing home saying, “Sorry, we're not getting our way so we're just going to board up the windows and leave town.” Not often.

What's so interesting is this time is that it's taken on farcical dimensions. Officials have called for a 21.2% cutback in certain Medicare reimbursements for docs. Did anyone, at any time, ever think this was going to actually fly?

So now we have federal regulators telling providers that, even though the cut officially went into affect Monday, they shouldn't submit claims for doc services because surely Congress or some other act of gods will come to the rescue. And they'll do it within 10 days, too.

But what if the cut isn't reversed? Well, guess who has threatened to take their black bags, close shop and go home, content to sip mint juleps on the veranda until the storm blows over? Or simply stop seeing poorer, often older, patients in favor of more lucrative, well-to-do customers -- er, patients.

That's right, the kid with the ball that everyone wants -- no, needs -- to play with. As youngsters, there were times we'd eventually just get fed up with the smart aleck and tell him to take a hike, nice equipment and all. When it comes to real-life healthcare, however, that's obviously not so easy to do.

So the physicians will again win on the payment issue at hand. It's just a matter of how much they'll get -- and how much they'll take out of a pool that other providers also draw from.

The good news is this should require some sort of bipartisan cooperation in Washington. That's right, a Democrat might actually have to agree with a Republican and vice versa. And something will be accomplished. And it might actually show a politician or two that thinking with one's own head -- for the good of the people -- isn't a fatal flaw.

Talk about setting a dangerous precedent.

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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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