Medicaid and Medicare are not charity. A physician chosing to treat a poor patient for free or a reduced reimbursment is charity. Those programs confiscate money from the public and hire the doc to provide the care so the political establishment can buy the loyalty of voters. There is no moral import to accepting or rejecting the wage.

The richest person in town, if they are over 65, gets the same enforced discount as the poorest. It has naught to do with charity. Over 50% of the wealth of the nation is in the hands of those over 65. Even many Medicaid enrolless are the unaknowledged offspring of men making very good money, some dealing drugs, who have offloaded the responsibility for the care and feeding of their offspring onto a gullible public. A great many others on Medicaid are the prosperous elderly who gave their substantial assets to their children while sending their healthcare and nursing home bills to other peoples children.

Where there is coercion, there is no charity.

I think these are very good questions that affect all of us, including physicians.

One answer is to keep working and your private insurance. Many of my patients have done this. This is not the real solution however as most private insurance simply follows Medicare rates nowadays. Supplements only pay up to the 20% of Medicare’s monopoly “allowable” not covered by Medicare directly. In general, providers may charge not a penny more or less than the rate set by Medicare. So if you want a “premium” experience with leather chairs, Starbucks coffee, and real face time with your physician, this is not going to happen within the confines of the present system. That is why most offices resemble a bus terminal nowadays.

I believe that as the situation and access worsens, the law will have to be changed to allow Medicare beneficiaries to use their benefit as partial payment with private insurance, health care savings accounts, or private funds paying the difference so that you may see whomever you care to without having to worry that they do not accept Medicare. That would be the American way.

Believe me that physicians should be worried about how they themselves will obtain medical care in the future. We are all patients someday.

This is not a tricky or sarcastic question, just an honest request for information from a younger baby boomer whose parents are elderly and on medicare and who herself is going to be on medicare at some point (if it still exists then).

The short answer, is they aren’t. More and more primary care docs are either walking away for the system or simply not entering the primary care field. There in lies the answer to your shortage.

Wait for medicare’s 40% cuts over the next five years to take hold. You’ll here primary care docs saying. “Medicare? are you serious, I stopped taking that years ago, and it was the best decision of my life.” Many are already doing so now and one need only look at medicaid to understand the trend.

Asking me, a doc to give you 11 refills on you morphine or oxycontin or hydrocodone is like calling the DEA myself, and turning myself in for trafficking in a controlled substance.

You sound like you need more than pain medication to help you. I hope you find the answers, because what you know you need is not what any doctor will ever be able to offer. Good luck in your journey.

Amen.
# posted by Anonymous : 12:07 PM”

Yikes, that’s a good one. I can remember all the little premeds who used to “offer their services” free of charge at our hospital, so the little SUCKUPS could write on their resumes that they were interested in patient care.

Now those little pissheads want to be paid.

Then the government asks you to pay for this privilege by seeing ahandful of poor patients at a reduced rate, and you balk. So yeah, let’s bring back the free market you doctors say you want so badly, and go back to the days when you could buy drugs without a prescription, and doctors had to travel 30 miles to get paid with chickens and goats. I’ll be happy to wave hello to you as I walk out of the pharmacy with my $15 bottle of laudanum in hand. As the old saying goes, be careful what you ask for, you might get what you deserve.

Amen.