ZOMG! Doctors are leaving Medicare in _droves_ !1!!eleventyone!1!!
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.
Dr Reece, blogger:
I have a prominent friend, a staunch friend of doctors and long a leader of organized medicine, who has often told me words to this effect,” If it weren’t for Medicare, doctors would have supported single payer a long time ago.” Many doctors simply can't stomach Medicare's policies.
This bodes badly for the future. Some 78 million baby boomers will start becoming eligible for Medicare in 2011; a shortage on internists is developing and is expected to reach 35,000 to 45,000 by 2025; 29% of Medicare beneficiaries are already having a hard time finding a doctor; and only 40% of primary care doctors now take new Medicare patients.
The root problem is that Medicare pays less, usually 20% to 40% less than private plans, depending on the state and region of the country and the paperwork is time-consuming and distracts from care for other patients. For practices having a hard time making a go of it, new Medicare patients are simply not worth the trouble or the expense. Given the current Medicare fee structures, many doctors feel a single-payer Medicare-for-all would put them out of business.
If it weren’t for Medicare, doctors would have supported single payer a long time ago.
Ouch. That doesn't bode well for our chances, nor do I have a good feel for just how true this might have been in the past. But lots of doctors have said recently that yes, they do want single payer now. What gives?
The shortage of doctors taking Medicare, this I've learned a little about recently. This problem has, like many problems, multiple facets [zomg! another hydra!].
Taking the obvious one first, doctors' pay. Dr Reece says that privae insurance pays doctors 20-40% more than Medicare pays. The 40% sounds a bit high maybe [well, maybe not] but according to the Lewin Group's recent report on the much-vaunted "public option" Medicare pays doctors only about 80% of what private insurers pay doctors.
The trade-off is that Medicare hassles doctors much less [don't have to spend hours on the phone haggling over pre-authorization, for example], has less evil paperwork, and pays much faster than do private insurers, thus cutting down on doctors' overhead and providing them with a dependable cash flow. And sure enough, if you tootle around the docosphere, you'll find doctors who are quite happy with Medicare [apologies for the lack of linky goodness].
There are glitches, though.
One of those glitches is [surprise, surprise] Medicare Advantage, aka Medicare Part C, the privatized part of Medicare. Not only is Medicare Advantage costing the taxpayers more than traditional Medicare costs, it's costing doctors more too, and paying them more slowly to boot. And some patients are leaving their Medicare Advantage managed care plans, often citing inability to get care as one of the reasons [that, and costs]. Can't blame doctors for not accepting Medicare Advantage if they think their patients are getting short-changed.
But even traditional Medicare has been causing some problems recently.
One of those problems is my favorite pet peeve, government automatically awarding contracts to the lowest bidder. You do get what you pay for [up to a point]. Medicare has recently redone their contracting [they contract out the administration of their insurance, actually]. Some of the new kids on the Medicare administration block appear to have bitten off more than they can chew, have been overwhelmed, and have been very late paying their doctors, to the point where doctors have taken out loans just to stay in business.
At roughly the same time, Medicare was assigning all their doctors new ID numbers [don't ask] and had drastically tightened the rules for submitting claims, moving their practices to a new address, some other stuff that both the doctors and the brand new contractors were somewhat blindsided by. In this case doctors were again getting paid slowly because of inept contractors, but even worse, doctors were unknowingly violating various of the new rules and getting kicked out of Medicare altogether, often for months at a time.
Dang, after a few experiences like that, I'd believe that government can do no right and storm off in disgust and fury too, but let me just point out that the new ID numbers, new contractors, and new rules are all products of the Bush regime.
It strikes me that if we had Medicare for all, if the pols all had to get their health care paid for by the exact same system as the rest of us, that maybe, just maybe, they'd fuck with it less.