MIKE BURGESS: How To Reform Medicare Without Cutting Benefits

Thanks to Elon Musk and President Donald Trump, Washington has zeroed in on reducing inefficiencies, waste, fraud, and abuse across the government. With one program in particular drawing the interest of both sides of the aisle: Medicare.

As is par for the course, Democrats are telling the American people any Medicare reforms are tantamount to “cutting benefits.”

Enough fearmongering from the left.

As a former member of Congress and M.D., I can tell you: reforming Medicare, without touching benefits, is absolutely possible.

One way to do so is common-sense site-neutral payment reforms.

Right now all across the country, big hospital systems are buying up smaller physician practices and rebranding them as “hospital outpatient facilities” – all so they can charge two to three times more even though patients are seeing the same doctor and receiving the same service.

For example, Medicare pays $255 for an epidural injection when provided in a physician’s office, but the cost for the same injection increases to $740 when provided in a hospital-owned facility.

This defies common sense, costs patients and taxpayers more, and limits patients’ choice over time as the only clinics left will be owned by big hospitals, who will then own so much of the market they’ll have unchecked power to set exorbitant prices for patients.

Congress has been keenly aware of this problem for over a decade, yet no action has been taken to solve it.

With Washington’s renewed sense of reducing waste, it’s time for Congress to finally enact comprehensive site-neutral reforms that could save more than $150 billion over 10 years for the Medicare program, and reduce beneficiary premiums and cost sharing by over $90 billion.

Insurance companies and the big hospital systems, who profit handsomely from inefficiencies in Medicare, oppose this common-sense reform – and it’s no secret why.

These groups and their powerful lobbies have spent years finding loopholes, optimizing their profits, and scaring citizens and politicians away from much needed changes, spending millions in ads to warn of the “dire” consequences of reform.

They argue that up-charging for physician services is crucial to their survival, leaning on fearmongering about rural hospitals.

This is a red herring.

Rural hospitals are critical to millions of American families across the country. We all agree that ensuring their survival is paramount. But there are ways to support the important work of rural hospitals without increasing prices for those rural patients (dollars that just end up enriching large and highly profitable hospital systems in the rest of the country). One option with bipartisan support would repurpose a portion of the savings from reforms to aid struggling facilities.

Allowing inefficiencies and distorted incentives to fester has allowed big hospital systems and insurers to line their pockets at the expense of taxpayers and patients. It is poor fiscal stewardship on the part of policymakers.

We all want Medicare and the federal budget to be sustainable for future generations, but profiteering of the entrenched health system interests is thwarting this possibility, increasing costs for everyone, and creating worse outcomes for patients. It is within Congress’s power to change this, and it should.

Now is the time to enact common-sense site-neutral reform, improve care for American families, and save the taxpayers billions.

After spending nearly three decades practicing medicine in North Texas, Congressman Michael C. Burgess, M.D., served as Texas’ 26th Congressional District from 2003 to 2025. During his time in Congress, he served on the House Energy and Commerce Committee as the Chairman of the Subcommittee on Commerce, Manufacturing, and Trade. He also served on the Rules Committee, the Helsinki Commission, and was the original founder of the Congressional Health Caucus.

The views and opinions expressed in this commentary are those of the author and do not reflect the official position of the Daily Caller News Foundation.