EARLY this year, Barbara Plumb, a freelance editor and writer in New York who is on Medicare, received a disturbing letter. Her gynecologist informed her that she was opting out of Medicare. When Ms. Plumb asked her primary-care doctor to recommend another gynecologist who took Medicare, the doctor responded that she didn’t know any ”” and that if Ms. Plumb found one she liked, could she call and tell her the name?
Many people, just as they become eligible for Medicare, discover that the insurance rug has been pulled out from under them. Some doctors ”” often internists but also gastroenterologists, gynecologists, psychiatrists and other specialists ”” are no longer accepting Medicare, either because they have opted out of the insurance system or they are not accepting new patients with Medicare coverage. The doctors’ reasons: reimbursement rates are too low and paperwork too much of a hassle.
I certainly don’t have to read the rest of this article as I have seen the effects of decreased Medicare reimbursement at the office where I work. I work in dermatology, so pretty close to half if not more of our clients are on Medicare so my docs can’t opt out of the system. What it means for us is working more for the same pay. The docs have to see more patients in a day, so the patients don’t get as much individual time with them. One of the docs is in her mid 50’s and will retire if things get too bad and the other is doing more cosmestic work and seeing fewer patients. Things WILL get worse as more babyboomers retire. I’m a tweener and by the time I retire the system will be bankrupt.
I think this is the Achilles’ heel of the move to socialize medicine in this country. Doctors can just refuse to accept patients on the government dole because of the paperwork hassle.
So many lies being used to disguise why doctors opt out of medicare, the real reason is they feel sure that those who truly depend on medicare are too poor to have their rights protected under the law.
The claim that reimbursement rates are too low is a lie. Medicare’s reimbursement rate is far higher than medicaid. Even doctors whose practices are in public hospitals, which get most of their funding from the federal and state government, have been discriminating against medicare patients for a number of years now. It’s been a violation of federal law for them to do so, but like so many other laws our government refuses to enforce, like our immigration laws, and our national sovreignty, worker rights protections, medicare, a program that was created to ensure that poor elderly and disabled citizens would not be deprived of the access to health care they desperately need. My family experienced the sad truth when my late husband was forced to rely on medicare and social security when he entered end stage organ failure. We thought his problems were over when he was approved, but upon calling the specialist’s office at the state’s public hospital in ’03, we were told that because of the health care crisis, they had to make a cut somewhere, and they chose medicare patients. Back then, they would only accept those on medicare, if they could afford an expensive supplemental health insurance, which we could not afford. My husband went without any access to the tests and specialist health care his critical illness required for the 2 years it took to get him approved for medicare, and then 3 additional years after being approved. 5 years without it altogether, for a person with a lifethreatening health condition. The only other care he received was when he was so sick, he would be seen in the ER. In ’06 they were willing to admit him, as his blood ammonia level was so high, he was retaining an enormous amount of fluid in his abdomen. Upon finally conducting the normal tests on his fluids, they diagnosed with with a lymphoma, in the 4th stage, he died three weeks later. Doctors now feel free to not even pretend to care about medicare patients, they feel entitled to dump medicare patients, because they know the government will not do anything about it. So much for “democrats” claims to care about “social justice” and “civil rights”. Obama was ready to deprive our troops of their government health care benefits, until he was shamed out of it.
[blockquote] The claim that reimbursement rates are too low is a lie. Medicare’s reimbursement rate is far higher than medicaid.[/blockquote]
Mari, I am sorry about your husband, but you do not understand the business of medicine. That Medicare pays more then Medicaid is a vacuous statement. I lose money on every medicaid patient that I see. It’s negative money. Many of my colleagues simply opt out of medicaid as a result or have one medicaid slot per day or per week. I do not because I am a fool – a fool for Christ. Believe you me, we have discussed limiting our medicaid patients at our office, but how can I? “Let the little children come to me, and do not hinder them, for the kingdom of heaven belongs to such as these” convicts my heart.
The reimbursements for medicare have been steadily falling and therefore so are the numbers of physicians who are willing to see medicare patients. It is simple economics, not a violation of “rights” of poor, elderly folk. Also, there is a shortage, soon to be a dire shortage, of physicians who work in a geriatric specialties – internal medicine, medical oncology, geriatrics. So perhaps we should force physicians to see Medicare patients? That will really make matters worse.
#2, that will lead to fewer doctors practicing in the US – either they’ll do something else or move out of the country. And then we’ll be that much more like Canada, which has shortages of doctors and the long wait times to see them. When my dad was practicing in upstate NY, many a Canadian came to see him for care….
The really big question is why are people over 65 not allowed to opt out of Medicare without losing 100% of their Social Security? Medicare is a dundersome government bureaucracy that ill serves both doctors and patients. At a minimum it should be voluntary.
Having lived under Canadian health systems, this is just a taste of what the new administration has in store for everyone. Forget the medical messes in the UK, Canada, and elsewhere — look at US health care systems when government get involved. Medicare, Medicaid, the VA, Walter Reed, Indian Affairs medicine …
Run, don’t walk, in the opposite direction.
It isn’t just medicare…medicare supplimental ins. is also a problem. I’m told that one company pays a grand total of $2.00 per visit. That does not cover minimum wage for the extra office help required to handle the paperwork!
Unfortunately, things will get much worse as our dear Speaker of the House just opined that, “Health care is a right, not a privilege.” This turns the idea of rights on its head and has very ugly consequences for us all.
Our family has Medicare and Medicaid, but we also have a retirement policy that kicks in and aids us once the two government aids is not enough to pay everything. Our medical center seems always easy to get along with. Also a bit of advice to the youngsters – try as hard as you can to contibute to an IRA. Even a small valued one helps when the time comes.
The general public does not understand how the “system” works. Medicare and Medicaid have the price fixed. Price fixing always results in shortages. The doctor can’t charge more and the patient can’t offer to pay more. That can send you to jail! I am a geritrician and am on Medicare. My lab has been closed for seven years because the reimbursment is way below the cost and I can’t afford to supplement it. I take no new Medicare/Medicaid patients, except as consults from other physicians and then only for the question consulted for. I also take new nursing home patients, but that is now rare everywhere. We doctors can do free or underpaid care, but we can’t pay the overhead, nurses and office managers pay, etc. In our community it has been fourteen years since a new doctor has come to town except for foreign doctors who are on a salary at the hospital (and they loose money on them) Federal health clinics would help but our Congressman has blocked it four times. He only will approve a company that gives him about fifty thousand dollars a year to his campaingn fund. They are incompetant to open another clinic and don’t see many at their other clinics. Now anyone can get “free” care at the hospital ER and can’t be turned away. Hospitals are now being squeezed so they try to limit services by not hiring doctors for expensive and poorly reimbursed service. I could go on a long time about what is causing the problem, but basically, government is the problem. No matter what government program is proposed, none will increase the number of doctors or nurses who are opting out and retiring. Only two percent of med school graduates are going into primary care. But since the American people have decided to go down a path that is doomed, I hope the people enjoy the consequences.
It is too bad that Clueless doesn’t post here any more. He (?) had similar unique perspectives on the subject, also being a doctor.
I miss Clueless’ voice on the forum.
Peace
Jim Elliott <><
There are times when my wife and I are glad I made a career in the Air Force…….especially since I am rated at 100% disabled by the Department of Veterans’ Affairs and have full coverage……and this is one of those times. Even though I’m 71 and my Primary Care System is Medicare, I choose to use the VA system, which is my Secondary Caregiver. My wife is covered by Kaiser, but she is a veteran as well, and she can also be seen by the VA since she is my dependent. Fortunately, our local hospital accepts Medicare.
Military has always had great medical care in the field and at home. The VA has improved tremendously in recent times. I am thankful for my VA benefits. I hope I don’t need them, but I am glad they are there if I do. Military is a great career oportunity as well. Young people don’t value the retirement and medical benefits when they are young, and I fear we are going into another Jimmy Carter antimilitary phase now.
Robroy, I commend you for your commitment to serving those children on medicaid. The point is however, that while I’m sure the compensation for medicare has fallen, the rates for medicaid no doubt has as well, but the need for access to health care doesn’t go away. The programs have become an excessive burden for numerous reasons, most especially the outsourcing of jobs, and the displacement of citizen workers, in jobs that formerly paid fair wages, by cheap foreign labor, both illegal and through the exploitation of our visa programs. Citizens who are deprived of work, and less able to find adequate employment to allow them to purchase insurance, will unfortunately require assistance. The illegal aliens here, whether working or not, are being subsidized by all welfare programs, including medicaid, while the citizens who worked in those same jobs in the past, at the wage standards, paid their own way. The same people complaining about how onerous it is to continue medicaid and medicare are the ones who complained about paying citizen construction workers, electricians, carpenters, painters, roofers, landscapers, gardners, housekeepers, childcare, janitors, and so on. They believed that American made products, were too expensive because citizens were paid fair wages, that those goods would be cheaper, if the jobs were sent overseas. The cost of clothing, cars, foodstuffs, drugs, everything under the sun, now manufactured and grown overseas, has not resulted in less costly items, and have revealed that the costs skyrocket, because the CEO’s of those companies are making increasingly higher salaries, bonuses, perks, golden parachutes, the cost of transporting those goods, while the quality is shoddy, and at times dangerous to one’s health. Hospitals don’t want to hire citizen janitors and housekeepers, no, they hire that illegal, cheaper foreign labor, which has lead to, as in the UK, Canada and in Europe, MRSA, because of inconsistent and poor sanitary habits of that cheaper foreign labor. Hospitals no longer have the clean smell and appearance I remember from the past. No society can afford to displace it’s citizen workforce, destroy economic independence, to allow the wealthiest to have a free ride, and then exploit the safety net programs as a form of corporate welfare, to subsidize that cheap foreign labor force, and then claim that they have to deny citizens the safety net programs that they have paid for all their lives, when they are being put into dire economic hardship, because of the greed and corruption of the wealthy and powerful in private industry, and in the public sector, including government. The demand for amnesty, as in the past, will lead to an even greater increase in more illegals coming, as well as from the chain migration those given amnesty will bring in. Elderly parents, grandparents, siblings, aunts, uncles their children, who then will also have the ability to bring more relatives in. Are poor citizens supposed to just roll over and die because it’s more cost effective? Tell me, in the brave new world that is being created, do you believe that the government won’t gut your wages as a medical professional, deprive you of the right to earn a living, to serve the needs of their cheap foreign labor force, that now believes it’s entitled to discriminate against, even kill citizens, and get away with it because they’ve gotten used to being given preference.
Jeffersonian, oh, but the speaker doesn’t really believe it’s a right, at least when it comes to citizens. When my husband was denied the health care he needed under medicare, Senator Jack Reed’s office refused to help, because he inferred that medicare wasn’t a federal program, which is a lie.
Speaker Pelosi told a gather of illegal aliens a few weeks back that they were “patriotic” because they were helping her to push the country in the direction she wished it to go in. This is the same woman, in whose state, hospitals, health centers and clinics are closing because of the cost of paying for free health care for illegals. She still believes we have a worker shortage, when citizen families are living in tent cities, Hoovervilles, across her state and in her district (they exist across the entire country as well). The fact received attention, because these families were mostly formerly middle class families, who had jobs, homes and apartments, who have lost their jobs. She’ll go to a Catholic church with Rep. Luis Gutierrez, to tell illegals they are “patriotic” that enforcing our laws is “un-American”, yet she refuses to visit now homeless citizens, even veterans in her own city.
What she advocates is not a lessening of poverty south of the border, but a rationale for the status quo that created that poverty, and a desire to impose that status quo here. Her much loved illegals will ultimately find themselves in far worse situations than those they thought they were leaving behind in Mexico, etc.. instead of working to change things in their home countries, their dislike of America and it’s people, believing that they are only hurting us, makes them willing to be exploited to ultimately enslave themselves.
My husband and I are five years from Medicare and dreading it. I understand little about it at this point, but I have been told that practically speaking we must go on it if we wish to have insurance at all after age 65. My husband’s employer does not offer insurance past Medicare age, as is now common. Since very few people reach 65 and don’t have some sort of pre-existing condition, and since everybody is on Medicare, I am told it’s nearly impossible to continue to have private insurance coverage, and it’s also illegal for people like us who could pay an extra fee to a doctor willing to take us to do so.
If anyone knows better news about over-65 care, I’d like to know it.
I can give you much better news than you are hearing. I have practiced estate planning and elder law for almost 20 years. I have found people with Medicare and Medicare supplemental insurance generally get excellent care. None of my clients have had any problems finding excellent physicians and hospitals who will take them, and prescription drugs are generally affordable under Medicare Part D.
Some groups in this country want to destroy the Medicare system and attack it at every opportunity. The fact is that the these groups have fought so hard to starve the Medicare system out of existence that they are the reason Medicare funding is falling short of ideal. They want Medicare coverage to be bad, as that is the only way the can encourage people to abandon a system that they dislike, but which has resulted in health care coverage for tens of millions of senior citizens who never would have been insured by private insurance companies.
Doctors have a very different problem. They are unhappy with the compensation. I can’t blame them for wanting as much as they can earn, that is the way our system works, but the sad fact is as the middle class continues to shrink we may very well have reached a point where we simply cannot afford to pay what some physicians require to encourage them to go into certain areas. Will that result in a shortage of physicians in those areas, maybe, but that will not be Medicare’s fault. Absent Medicare there would be even fewer physicians in those areas.
Blaming Medicare is very short sighted, as absent Medicare, many senior patients would have no insurance at all. I think what many Doctors fail to realize is, these so called free market groups believe the elimination of Medicare will reduce, not increase, Physician compensation and thereby reduce the cost of health care to a level that people can afford it without government assistance. They believe under a pure market model those who could not afford insurance would forgo much of the health care they receive today. This would force Physicians to compete for scarce dollars and this increased competition would lower the cost of health care.
The insurance industry is complicit in all this as they also prefer a pure free market model where they can charge anything they want. In such a world people over 65 without preexisting conditions would have insurance and pay astronomical rates for it, increasing insurance company profits. Those with preexisting conditions would not be insured at all, and those with disabilities would be uninsurable at any age. Insurance companies do not want to insure sick people. They want to insure healthy people who are unlikely to need significant care. A majority of people over 65 would be left without health care coverage if Medicare did not exist.
Why do people think Medicare was enacted, in the first place. Because we had an excellent system of health care that a malevolent government wanted to destroy? No, because insurance companies were not providing coverage to older and disabled people at a rate they could afford.
Finally, it is not true that you cannot have private health insurance once you are over 65. If you and your husband have no preexisting conditions and you want private insurance, you should buy a private insurance policy now. It will be very expensive, but it is available.
It is also not true that you can’t opt out of Medicare without losing our Social Secuirty. A portion of Medicare is free. You can opt out of the part you must pay for. If you opt out you will have no coverage for Doctors.
I represent both veterans and non-vetrans. Most vetrans prefer to use Medicare and Medicare Supplement for local coverage over VA doctors and hospitals which in my experience Veterans believe find provide inferior care to local hospitals and doctors.
Thanks, MCPLAW, but naturally practically no one reaches 60 without some sort of pre-existing condition. Mine and my husband’s are both easily handled with medication, but any sort of condition at all is enough for private insurers to decline coverage.
It’s fine to say that doctors may earn too much, but for my part I don’t think it unreasonable for people who graduate with $100K+ debts to want to repay and also live comfortably, considering their education and responsibilities. At it is now, if we leave our current area after we go on Medicare, we might not be able to get doctors at our new location. Really, why not let people like us, who can afford insurance, just pay for it and continue as we are? Why does Medicare have to cover everyone, not just the poor?
Katherine,
You are missing the point. If Medicare did not exist you and your husband would have no coverage at all once you retire. If the insurance companies will not insure you now, they would not if Medicare did not exist. The Preexisting Condition issue has nothing to do with Medicare. That is a rule of the insurance company. They will not insure anyone with a preexisting condition. Medicare has nothing to do with that.
As far as Doctors are concerned yes they can earn anything that want so long as someone can afford to pay. But eliminating Medicare would leave people like you with no ability to pay for care. It would not increase the income of Physicians.
I think, rather, that if there were a large pool of over-65 people wanting medical coverage, the businesses would meet the market. Same if medical coverage were de-coupled from employment; a large pool of customers would bring market response.
There is absolutely no evidence to support your proposition. In fact all of the evidence is to the contrary and your proposition does not make economic sense. The insurance companies do not want to insure someone who is likely to cost them more than they will ever receive in premiums from that person. You make the presumption the insurance companies are benevolent and because they would have a more healthy people on private policies they would be willing to take on a large pool of unhealthy people on private policies. That is nonsense.
Insurance companies are in businesses to make money. They make profits by insuring as many healthy people as possible and avoiding issuing insurance to people who are not healthy. Just because you have a lot of people looking for individual policies is not going to change that model. In fact it is an insurance companies dream world. The only reason many people have insurance today is because they are in a group policy where a company says I can deliver 100 healthy workers, but you have to take my 5 sick workers. If each person had to apply for their own policy the insurance companies would sell policies to the 100 healthy workers but would not sell policies to the sick workers. Yes it would be cheaper for the 100 healthy workers, but the sick workers would be left out in the cold This is capitalism 101.
Likewise there are millions upon millions of people over age 65 who could never buy private health insurance at a rate they could afford.
If you do not trust Medicare, you and your husband can buy private insurance tomorrow. You simply have to agree to exclude from the policy any medical complication arising from your preexisting conditions. Which is exactly what you would be able to buy if Medicare did not exist.
Getting rid of Medicare would not make the insurance companies want to cover your preexisting conditions unless they could set your premiums at a rate that would assure them they would not lose money on you. You are unlikely to be able to afford that rate, and if you can, you can cover the cost yourself without insurance. So buy the policy that excludes the condition.