A recent best-places-to-retire article highlighted Bellingham, Wash., but Tom Curry, executive director of the Washington State Medical Association, thinks that evaluation omitted a chief concern for retirees:

“The article forgot to mention that if you’re going to do that, you have to bring your own physician with you.”

It’s a funny quip. Possibly painfully funny.

Unless Congress acts soon, the feds plan to cut physician reimbursements for Medicare by 10 percent on Jan. 1. Additional planned cuts would reduce payments by 40 percent by 2015. As baby boomers begin retiring en masse, the joke will be on them, because it won’t be easy to find a doctor who takes new Medicare patients. This will be especially true in Washington state, where Medicare reimbursement rates are among the lowest in the country.

The Spokane County Medical Society reports that the region has experienced a 20 percent decline in the number of doctors serving a growing number of patients since 2001. The average age of the remaining physicians is 47, which means many of them will be retiring themselves. A 2006 survey of Washington state doctors found that 39 percent were taking no new Medicare patients. One in four patients reports difficulty in finding a doctor.

The decline in reimbursements also affects Tricare, the military’s insurance program, because its rates are pegged to Medicare.

The origin of the cuts lies in a 1997 balanced budget agreement. To stem growing medical costs, Congress concocted a formula that pegs physician payments to the general performance of the economy. This ignores the long-standing reality that medical costs have outstripped economic growth and inflation. The reason for medical inflation is complex, but this formula, in effect, lays the blame on providers. But, oddly, not all providers. The cuts do not affect hospitals, which will continue to get annual reimbursement increases.

Medicare spending is a huge federal budget item, and it is imperative that Congress find ways to rein in costs, but across-the-board cuts to doctors will increasingly hinder access for patients.

Plus, that solution presupposes that all Medicare spending is equally effective. Recent studies have shown that isn’t true. There are significant regional differences in Medicare spending without corresponding improvements in outcomes for patients. The Northwest fares well on the cost-to-quality scale, which given its low reimbursements suggests that there is money sloshing around the system that could be cut.

Congress needs to trade its meat cleaver for a scalpel as it looks for responsible cuts in Medicare spending that won’t block access for patients.