Associated Press
In this July 12, 2012 photo, a man using two canes is helped in the waiting area at Nuestra Clinica Del Valle in San Juan, Texas.

Because of simple economics, more and more doctors are refusing to accept new Medicare patients or dropping the ones they already serve. The government's reimbursement rates to these physicians have not kept pace with inflation, therefore they are finding it no longer profitable to participate in the program.

Viewed in the overall scheme of health care for the elderly, this problem right now is slight. The Wall Street Journal last week reported figures from the Centers of Medicare and Medicaid Services showing that 9,539 doctors dropped out of the Medicare program in 2012, out of about 685,000 doctors nationwide.

But the trend is growing, with three times more doctors dropping out last year than three years ago. And with human nature as a guide, it's easy to predict the numbers will grow considerably as the full effects of the Affordable Care Act, or Obamacare, kick in.

The Congressional Budget Office has estimated that, over 10 years, Medicare reimbursements will drop by $716 billion due to the Affordable Care Act. Medicare's trustees have predicted this will cause 15 percent of Medicare providers to lose money by 2019, with the percentage increasing gradually to 40 percent by 2050.

In addition, an aspect of the Affordable Care Act that once received considerable attention still looms. It is that the act depends on both cuts to Medicare and an increase in Medicare payroll taxes to keep the program solvent, but it also depends on this same scheme to pay for the act's additional entitlement costs.

Yet cuts to Medicare reimbursements will require congressional action, which seems increasingly unlikely. Congress has consistently voted to postpone such cuts, for obvious political reasons. The Affordable Care Act includes automatic cuts in 2014, but it's hard to see how politicians can let that happen, with so many senior citizens relying on the program.

But the choice is clear. Either let the cuts take effect and anger doctors who, after all, need to turn a profit, or reverse the cuts and try to find other ways to pay for the Affordable Care Act while also keeping Medicare solvent.

That is no way to run a national health care system.

The American Academy of Family Physicians surveyed doctors and found that 81 percent of them accepted new Medicare patients last year. That was down slightly from 83 percent in 2010. One can only wonder what the percentage will be when 40 percent of physicians no longer can earn a profit through the program.

Cost isn't the only factor. Paperwork plays a role, as well. By 2015, doctors who don't submit their records to Medicare electronically will face penalties. While there are clear advantages to doing this, especially in terms of how quality of care is measured, many older physicians are either ill equipped or unwilling to make such a change.

The Affordable Care Act is in a strange state of limbo at the moment, with the mandate for employers to provide coverage having been postponed until 2015. No one seems sure how the mandate for individuals to obtain insurance can go into effect next year independent of the employer mandate. How can the government be sure someone is not covered at work without employer participation?

Political realities make it impossible to repeal the act. Such attempts become little more than political sideshows that do nothing to solve problems.

It's long past time, however, for Congress to get serious about fiscal responsibility, and that includes reforming how entitlements are funded and getting serious about dealing with the long-term costs of the Affordable Care Act.

Physicians, like everyone else, respond to financial realities, and few people want to work for less money year over year. When Medicare reimbursement drops, the net result will be fewer people served, and that is not an acceptable outcome.