Medicare is headed toward insolvency. Congress is fooling itself if it thinks that a short-term fix such as cutting the reimbursement rate to doctors by 10 percent will help.

All that will do -- according to the doctors, at least -- is encourage even more physicians to retire or stop accepting Medicare patients because the government doesn't cover the cost of treating them.

Congress needs to come up with a better solution. It's a crisis for elders who can't find doctors to treat them, especially in rural areas.

This problem also involves military families that depend on Tricare coverage, because Tricare's rates follow Medicare's. Many Oregonians are serving overseas in Iraq, Afghanistan and elsewhere; they should not have to worry that their family members can't make do on inadequate military insurance.

It makes no sense that the system pays some states, including New Jersey and Massachusetts, nearly twice the average reimbursement that Oregon gets for a Medicare patient's care. Oregon has been penalized for spending its Medicare dollars carefully; it should be able to use the savings to provide even better care to its citizens.

Instead of nibbling around the edges, Congress must have the guts to reform the Medicare system before it goes broke. With the huge baby boomer generation approaching retirement, that day is projected to come in a decade or so.

Someone in Washington, D.C., must be brave enough to admit that Medicare can't afford to continue paying for every kind of treatment for every person.
Years ago, Oregonians faced a similar dilemma: how to allocate a limited amount of state and federal money to care for the poor. Residents gathered in town hall meetings throughout the state and decided that the highest priority should go to treatments such as immunizations for children, which effectively prevented illness at low cost. The lowest priority would go to expensive, experimental treatments that were unlikely to do much good. That system worked well until the recent recession caused drastic cuts to the Oregon Health Plan.

On the national level, someone will have to make similar decisions: What can Medicare cover, and what will people need to pay for out of their own resources, if at all?

It will take tough steps like this to keep Medicare alive in the coming years.