Docs Refuse Medicare

I know without having to read the New York Times that docs are refusing to take Medicare patients because as an under 65 year old on Medicare due to disability I’ve been on the losing end of that stick for years.

“For the first time” the New York Times reports significant numbers of doctors are refusing to take new Medicare patients because the George W. Bush/GOP led government recently enacted a 5.4% cut in reimbursement rates to physicians who participate in the program. (Pear, 3/17/2002). According to the story 17% of family doctors not longer accept new Medicare patients. One doctor admitted to the Times that he does “not take any patients over the age of 60 because they will be on Medicare in the next five years.”

Meanwhile, the Times reports that hospitals, nursing homes and HMOs are also “demanding more money” for treating Medicare beneficiaries and HMOS have dropped 2.2 million Medicare beneficiaries in the last four years, for the reason that reimbursement is too low. Nothing can result from this but 2nd class health care and more needless suffering for seniors and disabled persons on this public program.

In part the current situation can be attributed to the business-ization of medicine. Doctors in America expect to live the lifestyle of millionaires, certainly way above the average person’s income and many will do anything to achieve the lifestyles of the rich and famous.

For example, after a recent surgery I needed access to a specialist. A friend referred me to “the best” in the field. This particular doc charges $350 per visit. The doctor did not normally take Medicare. When I called to make an appointment I could hear the office manager practically laughing on the other end of the line when I told her I had Medicare. But my friend’s referral got me in anyway for *one* consultation though I was constantly reminded by the office manager that this doctor charges $350 per visit. I was being done “a favor.” The doc gave me a prescription for medication and later when I had some questions about it, he gave me a referral to several docs, none of whom it turned out took Medicare either as a matter of course.

Can’t these doctors who charge $350 per visit afford to take a few Medicare patients? The fact that they refuse to see that a portion of their practice are Medicare patients regardless of the payment, indicates that money now rules medicine — docs pick and choose patients based on what insurance they have, who can pay more. NO doctors should be allowed to charge that much for health care but if the government is going to reduce payment to doctors then it needs to also legislate that doctors MUST take Medicare patients and make sure that a percentage of their patients are Medicare beneficiaries.

Contrary to the NY Times story that it is “the first time” docs are not taking Medicare when I got on Medicare some ten years ago, I was stunned that it was looked down upon and less welcome as insurance by many providers. I’ve run across GYNS, internists, general practitioners, and others in private practice who tell me (once they learn that my insurance is Medicare) that “they are not taking any new patients.”

There are problems with Medicare aside from low payments. I’ve found that many chiropractors will not take Medicare at all. They cite excessive denials of payments by Medicare even though chiropractic care is covered by Medicare. Dealing with Medicare for chiropractors often means being buried in appeals over payments that are a pittance in the first place, they say.

My chiropractor continues to take Medicare because she cares about people. She went into the profession to heal people – an idea that often gets lost in the scuffle for money. Should she have to spend hours sending reports to Medicare when she is denied payment and be penalized for putting people first?

Never have I heard of a medical doctor being refused payment for an office visit. Even if the doctor did nothing to resolve the patient’s needs! Medicare needs to stop treating chiropractors as if they are frauds. I’ve been to many medical doctors who did NOTHING for me but they collected a relatively large sum of money anyway. Every chiropractor I’ve gone to has given me some relief.

In the face of the downgrading of Medicare, I’ve resorted to going to UCLA for my health care needs because as a public university their health care network is obliged to take Medicare patients. What do people do when they don’t have a university near them? And given the cuts to research hospitals over the past years, will the university health care networks be able to maintain?

Just last week (March 22) veterans in Los Angeles demonstrated in front of one of the VA hospitals here. They contended that government has cut back services to such an extent that they no longer are receiving appropriate care. On veteran explained that the orthopedic department had been completely shut down and that services were a shell of what they used to be.

Medicaid is facing even worse violations in cutbacks. State health care costs are growing while states face budget shortfalls that total about $15 billion for 2002. As a result some states are just outright slashing health care funding, while other states are looking for more flexibility to make tradeoffs in benefits and overage. What they mean is RATIONING health care to those already on the program. While some states are expanding the numbers of people who can qualify for Medicaid they are also planning to cut services and benefits to make room for the additional people to be added on.

Some states are considering cutting back on prescription drug coverage for Medicaid recipients. They can do that, there is no law that says they have to cover prescriptions. Another plan is to cut back on what drugstores get paid per Medicaid prescription. This has drugstores threatening to end Medicaid services.

Some governors want the federal government to chip in some extra funding for Medicaid in these times of budget shortfalls but George W. Bush is against any temporary increase in federal Medicaid funding for states so the GOP governors have opted not to pursue that course.

During the House of Representatives debate on concurrent resolution of the Budget, fiscal year 2003, Representative Pete Stark (D-CA) got to the meat of the matter:

“Mr. Chairman, there are some of us who remember this world in the 1930s, when Hitler suspended the Bundestag to promulgate conservative ideology and not let people speak. It is a shame that the Republicans in the House, Mr. Chairman, have taken up that same ideology and are denying a chance for debate and open discussion of a budget. It does smack of fascism; and it is too bad, because the American people will recognize that and understand that in a free economy, and in a free country that created programs like Social Security and Medicare and special education and aid for dependent children and aid for people who are unable to care for themselves, for the disabled, that to deny them care is obscene.

I think it will be quite clear that, for whatever reason, whether it is deficits or anything else, that the overwhelming desire of the Republican Party is to destroy programs in the Federal Government, except those few intended for the very wealthy.”

In Beyond Ramps (Common Courage Press 1998) I demonstrated at length the efforts of the Gingrich era congressional attempts to destroy what is left of Medicare and Medicaid. I predicted that they would chip away at these programs until they had destroyed the reputation of the public health care system causing the public to lose faith in these very important programs. This latest round is certainly bent on doing that. Doctors refusing to take Medicare is a huge public relations victory for the anti-Medicare faction.

George W. has got the mantle of terrorism to divert the public’s attention from his party’s desire to destroy our public health care system. His aim is to shift public funds to building the war machine, a public program intended for the very wealthy and members of his party. The vice president, Mr. Cheney, benefited from the Gulf War and is hot pursuit of another Gulf War and other wars against “rogue nations.” The war on terrorism is a perfect front for putting money in the pockets of defense contractors, some Bush cronies and large contributors to the GOP.

“Americans have no constitutional right to health care,” former U.S. Surgeon General Dr. C. Everett Koop said in a speech at the Huntsman Cancer Center in Salt Lake City in early March.

Koop held out that the Bill of Rights was intended to “protect people from government, rather than establishing a right to expect something from government.”

But public polls that indicate that growing numbers of Americans believe health care is a basic right.

Koop says, “someone has to provide for that right. … There would be a very heavy price tag.” Koop said that Medicare is an “effective laboratory for highlighting the problems of mass entitlement.” He said that while Americans have “the impression … that Medicare covers the cost of care for the elderly at no cost to them,” in fact, people have to pay into the program “for a long time before coming eligible.” He added that even then, Medicare does not cover “many vital medical costs, including prescriptions.”

Koop acknowledged that Medicaid “is even less effective” at offering health care to those who need it. Koop said, “If there is a right to health care, someone has to provide it. That means higher premiums [or] higher taxes or both.”

Actually it just means redirecting public priorities. The money is already there.

Perhaps it is time that we demand a constitutional right to health care. It seems that will be the only way Americans will achieve any worthwhile health care safety net.

Marta Russell can be reached at disweb

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