In this post, I suggest that the new healthcare bill will have unintended consequences of reducing the availability of primary care available to Medicare patients once it goes into effect.
The following is text captured from a thread that I participated in shortly after the House vote dealing with the question of access for more Americans under the new healthcare plan. My church friend, XXX, and I have discussed the issue at length over recent months, and we have agreed to disagree agreeably.
The reason I'm quoting the thread is that in a related post coming soon from Under My Rock, entitled "Well, Isn't THAT Special?? Is This Really Debate?," you can see how, apparently, I ruffled someone's feathers and that person's reaction to the following:
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Steve Boone
No, XXX, when your health care is provided by the government and you can't get quick treatment by a primary care doc *because there are too few to go around*, I hope you'll still be as exultant as you are now.
XXX
Your statement does not represent this bill (health care will not be exclusively covered by the government) and is completely unrealistic. You are certain the insurance companies have your back, Steve? They make their money denying claims. No secret there. You favor insurance companies rights to jack your premiums at will? Want to discuss pre-existing conditions or meeting runaway Cobra payments? Leaving the millions of hard working unisured is better than coverage? Mandated access to prevantative care is cruel? This is a quantum leap towards a healthier and well cared for society. I am sorry
you do not see it that way. How do you propose to care for the uninsured.
Steve Boone
XXX, first of all, let me repeat again what I have said to you in the past. YES, there is a need for health care reform in this country, a serious need. However, this is not the way to do it.
I realize you’re one of those people who ignores one little fact time after time: You can no more change the characteristics of The Market than you can stand on the shore and stop the waves. The Market will always do what The Market does.
Screw with The Market and you have “unintended consequences.”
Example? Your buddy, [Maryland Governor Martin O’Malley] Marty O’s brainstorm to raise the sales tax to 6% [in a 2007 Special Session of the General Assembly]. Should bring in more revenue, right? WRONG! The State Comptroller’s Office reported that, a year later, sales tax revenues were DOWN $76 MILLION. People who wouldn’t normally bother going to Delaware to pay 0% sales tax or wanted to buy clothes in Pennsylvania and save 6% sales tax DID so. The hit was hardest on the Eastern Shore. Who’d’a thunk it?
Now, remember what I do for a living. Healthcare billing. Yes, I’m aware that getting insurance companies to pay is a little more difficult nowadays. But Nancy Pelosi promised us that this new bill would increase access to care for all Americans. Bull.
Here’s just one example of where that pesky Market comes in: Medicare reimbursement will be cut by 20%. It’s in the bill, and CMS (Centers for Medicare and Medicaid Services) has suspended all payments since 2/28/10 until the new fee schedules are approved by Congress. This means that if I got $40.00 reimbursement for an office visit, [now] I would then only get $32.00.
If I’m a primary care physician with a geriatric patient population, what’s going to happen? My income is going to dive. I will have 20% less to pay my office space, my staff, my overhead, whatever. I have a couple of choices now. If I’m running a marginal practice, just eking by, I will probably close my doors. I’ll give people 3 months or so and close the practice because I no longer can afford to stay in business. Put that in 1,000 doctors’ situations, and what happens? The access to health care shrinks because there are fewer primary care docs to take care of Medicare patients!
Now, I’m running an OK practice, doing all right. I have a mix of patients, both Medicare and private insurances. The hit will be less on me, but, I may have to do the math and determine I can no longer afford to accept Medicare patients because it isn’t worth the paperwork and hassle and the reimbursement sucks. I send all my Medicare patients a note saying “due to reductions in payments by Medicare, I will no longer accept Medicare after May 1, 2010. Where’s the access to care now for these Medicare patients?
Now, I’m doing fairly well at my practice, I have a lot of well-to-do patients. I’m tired of messing with the insurance companies, I don’t want to deal with any of that any more. I can do the latest fad: tell everyone that I am changing my practice to a boutique operation, and if they pay me a retainer of, say $2,000 a year, I’ll see them whenever they need me, night or day. But, it’s a cash retainer, paid in advance. Again, there goes the number of available doctors!
And this is only a minor part of the bill, dealing with Medicare patients...
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