The doctor is in---in Washington DC today, struggling to get major changes approved in the nation's Medicare system.


  Texas Medical Association President Dr. Steven Brotherton says physicians are twisting arms to try to get a rewrite of what is called, in typical Washington fashion, the Sustainable Growth Rate for doctor reimbursements for Medicare patients.


  Brotherton says the result has been that payments to doctors for treating seniors and military families on Medicare isn't working, and some doctors receive only one third of what it costs them to treat these patients.


  "We've had sixteen patches to it and they’re not fixing anything," Brotherton said.  "We need to get a permanent fix.  It was a mistake to start with."


  Brotherton says unless the SGR is repealed in favor of another plan, Texas doctors will see another 24% cut in what they are paid by Medicare to treat patients kick in at the end of this month.


  "You only see 58% of doctors in Texas taking new Medicare," he said.  "Its not that they don't want to see those patients, its not that they don't want to keep treatment patients that they have been treating, it's just that they can't afford it." 


  The TMA says without a major fix, the ability of Medicare patients and dependants of military personnel to see a doctor may be drastically reduced.  Brotherton says it is harder and harder to treat Medicare patients and still be able to keep a practice operating.


  He says eventually, major changes will be needed to keep Medicare solvent, but he says that is for the Congress, not doctors, to make.


  "You could change the age of eligibility," he said.  "You could change what you're eligible for."