July 12, 2011
By Ed Koch
I’ve been told by a knowledgeable friend that doctors throughout the country are notifying patients that they will no longer accept Medicare payments for services rendered because they believe those payments are inadequate. When a physician does not accept Medicare and the patient is not otherwise insured – which is common – the patient is required to pay the full bill. Many patients are willing to go out of pocket rather than lose the services of the doctors who currently provide their medical care.
I have also been told that if a Medicare patient who pays out of pocket is admitted to a hospital, the patient will no longer be covered by Medicare’s hospital coverage and will find the hospital billing him or her directly. This is crazy, since hospital bills often run not only into the tens of thousands, but often into hundreds of thousands of dollars.
These problems will likely get worse. President Obama’s universal health coverage law provides for a $500 billion reduction in Medicare funding over a 10-year period. It is reasonable to assume more doctors will leave the system and require patients to pay their bills out of pocket. This matter must be addressed. If we are to seek ways to penalize physicians who reject Medicare and Medicaid patients, we must be sure to provide reasonable fees for both programs.
For a time, the Obama administration appeared to agree, as reported in The Times of June 27, 2011: “Alarmed by a shortage of primary care doctors, Obama administration officials are recruiting a team of ‘mystery shoppers’ to pose as patients, call doctors’ offices and request appointments to see how difficult it is for people to get care when they need it. The administration says the survey will address a ‘critical public policy problem’: the increasing shortage of primary care doctors, including specialists in internal medicine and family practice. It will also try to discover whether doctors are accepting patients with private insurance while turning away those in government health programs that pay lower reimbursement rates.”
The Times went on: “According to government documents obtained from Obama administration officials, the mystery shoppers will call medical practices and ask if doctors are accepting new patients, and, if so, how long the wait would be. The government is eager to know whether doctors give different answers to callers depending on whether they have public insurance, like Medicaid, or private insurance, like Blue Cross and Blue Shield.”
The Times also reported: “Most doctors accept Medicare patients, who are 65 and older or disabled. But many say they do not regard the government as a reliable business partner because it has repeatedly threatened to cut their Medicare fees. In many states, Medicaid, the program for low-income people, pays so little that many doctors refuse to accept Medicaid patients. This could become a more serious problem in 2014, when the new health law will greatly expand eligibility for Medicaid.”
The Times reported, “The calls are to begin in a few months.”
I was therefore shocked to read in the Times of June 29, 2011, “The Obama administration said Tuesday that it had shelved plans for a survey in which ‘mystery shoppers’ posing as patients would call doctors’ offices to see how difficult it was to get appointments. ‘We have determined that now is not the time to move forward with this research project,’ the Department of Health and Human Services said in a statement late Tuesday.”
A telling line in the Times article was “The decision following criticisms from doctors and politicians represents an abrupt turnabout.” The Times reported, “Having coverage is not the same as having ready access to care – a fact demonstrated in Massachusetts, which has come closer than any other state to the goal of universal coverage. A recent survey by the Massachusetts Medical Society found that about half of family doctors and internists were not accepting new patients.”
Who deserves the greatest blame for this scandalous state of affairs? Is it the physicians, or the politicians protecting them, or the Obama administration which has flinched so often when legislating into law the current universal health care legislation? I believe it is the Obama Administration and the Congress who deserve the blame.
The Obama administration flinched and gave in to the prescription drug industry depriving Medicare of the right to distribute prescription drugs to beneficiaries and to seek volume discounts in drug purchasing. Volume discounts – which are used by the Veterans Administration – could save up to a trillion dollars over a 10-year period. The administration also flinched by not allowing a “government option” for health-care coverage. Why is it the U.S. unlike every country in Western Europe, Canada and Japan and other countries, has been unable to successfully take on the special interests in the field of medical care?
The reports in today’s Times of July 5th are adding to the alarm that more doctors may join the movement not to serve Medicare and Medicaid patients since, “Obama administration officials are offering to cut tens of billions of dollars from Medicare and Medicaid in negotiations to reduce the federal budget deficit, but the depth of the cuts depends on whether Republicans are willing to accept any increases in tax revenues.”
The Obama administration defends the offer to further reduce federal funding to Medicare and Medicaid, with The Times reporting, “Administration officials and Republican negotiators say the money can be taken from health care providers like hospitals and nursing homes without directly imposing new costs on needy beneficiaries or radically restructuring either program.” Add these proposed cuts to the $500 billion cut already in the Obama budget, and doctors and patients indeed have to worry. Based on past performance, the Congress will not adequately finance these programs.
At some point, doctors who have families and expenses and a lifestyle may conclude that they can bear no further cuts to income and leave the profession, and they may be right. The federal government, like the health insurance industry, has the obligation to treat doctors fairly in setting fees if doctors are to accept those fees and be available. Putting a budget together requires setting priorities: surely Medicare and Medicaid are top priorities.
Of course, doctors have to be paid fair fees by the government, as do the insurance companies. If the fees are not fair, too low (doctors say some fees don’t pay the office costs), the federal government has an obligation to raise them. Of course, prescription drug companies have to be paid fair fees for their products. But when advertising costs are twice that of research and development, there is something wrong with the pricing of prescription drugs. The federal government has a role to play in fixing those prices. In Canada, the prices require governmental approval, and are up to 50 percent less than those charged in the U.S. Also many drug companies are indebted to the U.S. government for its basic research in developing drugs on which the companies profit. Does the U.S. government and taxpayer receive their fair share of the profits that will ultimately be made?
What is lacking in this whole tawdry business is leadership on the part of the Obama administration. What is clearly present and regrettable is the political fear displayed by that administration and the lack of courage on the part of the Congress. What is shocking is the greed of the prescription drug companies. We, particularly those on Medicare, look to our doctors to work their magic and extend our lives. We look to the government to keep our Medicare programs viable. The poorest of our population on Medicaid are even more vulnerable and dependant on both doctor and government. However, doctors should not expect their medical practices to become simply charities borne by them. There are roles for government to assume, surely Medicare and Medicaid are appropriate roles for the government to administer.
Shamefully, Medicare and Medicaid are being abandoned by President Obama and both political parties.