A physician who’s upset that the Medicare bill passed: “As a family physician, I’m deeply disappointed that the Senate voted on Wednesday to pass a bill that would limit health care choices for our growing aging population.”
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- Medicare drug negotiation
- My take: Medicare payment cuts averted
- Death of primary care: Who cares?
- Vetoing the Medicare bill
- Medicare fallout
- AMA: Permanent repeal of the Medicare physician payment formula must be part of health reform
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This thing aint over yet….Bush said today that he will still veto the bill. And the senate vote was far from veto proof with Kennedy ill, obama unreliable to show up, and 18 possible flippping republicans.
as a medical student i hope that it is vetoed. i have five years of residency so the cuts will have minimal effect on me. perhaps the medicare cuts may provide the impetus to effect change by a generation of doctors who were complicit in allowing the situation to deteriorate to the current mess it is in.
doctom
I’m glad to read an alternative opinion about this.
It seems unlikely that the whole Medicare Advantage program developed and grew as it did without some benefit to patients.
As a forum to highlight medical news I think it’s worthwhile for you to search out both sides of these issues.
1- Kennedy was present for the vote http://tinyurl.com/6y2dyr
2- While I think it’s good to hear both sides of the issue this article was *incredibly* biased – not once was the subject of the 10.6% cut in reimbursements to physicians with regular medicare mentioned, which from what I understand is the reason for passing this legislation in the first place.
I think the solution is reading material that presents a fair and accurate presentation of the problem, not horribly biased material on both sides.
Medicare Advantage Programs are handout to the insurance industry who gets more more money from the federal government and then gives less benefits to the seniors and providors. The brilliance of the plan is that it is easy for someone to confuse a vote against these “Advantage” plans as a vote against providing seniors with more access. But the AARP know the difference.
Have you looked at the Medicare Advantage contracts which you are by default enrolled in if you have any contracts with a health insurer providing medicare advantage? They pay 40-78% of the medicare rates. The insurance companies get an extra 13 to 17%. Please do the math. Right now I run around and see 30-35 patients a day and I need that in order to get a paycheck (I get paid last after all the staff and vendors). On days like today when I saw 15 patient and no patients showing up in the afternoon I wonder if I will have a paycheck this month. I let the staff go early and am waiting till end of the day for any walk ins. I know I am not the only one in this boat. I really don’t think having a lot of seniors on medicare advantage is going to help my situation. And if I am not around because I decide to abandon outpatient services then where will all the medicare or medicare advantage patients go? So I am not against seniors having more benefits but not at the my expense and a insurance companies profit windfall.
“Plans worked in concert with physicians to provide benefits beyond traditional health care, while lowering out-of-pocket costs for Medicare beneficiaries.”
What planet is this guy on? I have yet to see a Medicare Advantage Plan that was willing to work *with* me. All they do is work *against* me. First of all, their representatives tell my patients that they can still see me under the new plan. But really they’re just lying to get their commission for signing someone up (and where does that money to pay their commission for lying to elders come from? That’s right, your tax dollars!) So now I have my patients who are very limited in their English proficiency trying to switch out of the plans that my clinic doesn’t accept, and guess what? It’s really hard. I have an M.D. and can barely figure out how to disenroll. They have nobody else to help them, so who’s helping them (and gladly)? That’s right, me.
So let’s say my patient enrolls in a Medicare Advantage Plan that is accepted at my clinic (and a representative has, once again, pocketed a good sum of money at our expense). It’s impossible to even get a real person on the phone. Once I do, there’s nobody who can tell me what medicines are covered under the plan. And their “disease management” seems to be an LPN who calls them every few weeks to ask them how they are, but when I try to enlist them to help manage a patient’s needs they tell me I have to make a VNS referral. So much for working as a team. This Op-Ed is so amazingly biased I can’t believe it was published.
One would think the overall scheme is obvious to people smart enough to be docs but apparently not so I will paint it in primary colors:
Pay medicare advantage more than ffs medicare so the seniors will flock to it to get the extras–although they extras come not from efficiency but from more government money per recipient.
At the same time, squeeze ffs medicare so the remaining patients in it can’t find a doc who will take it.
Result: Medicare as we know it is then dead.
At the point, anticipated to be reached when the baby boomers start really stressing the tax base, medicare advantage can be squeezed down. Docs and patients alike will be stuck in it and the politicians will be at a hands-off distance from the specific cost containment measures as those will be decided upon by the management of each advantage plan.
Sort of outsourcing the inevitable entitlement shrinkage to come.
That is the Republican plan.
The other side has the opposite plan. Squeeze Medicare advantage while putting more and more of the population in ffs government entitlements until we reach a point of effectively a single payor system. Then the control of individual health care decisions will be where the left has always thought all decisions should be–the federal government. They really don’t have a plan after that except that they are confident that with enough control they will be able to exercise their self-evident intellectual superiority and God-like wisdom to solve all the problems.
There is a third plan. One might call it the “conservative” plan or the “libertarian” plan I suppose. It doesn’t matter one calls it because it runs right smack against the assumption that someone else should pay for healthcare and that everyone should get the same healthcare. So it will not happen.
That would be for the government to limit medicare fees to what the budget will support, while allowing docs full balance billing on a case by case basis at their discretion. One assumes that medicare payments would drop as the baby boomers retire and docs would charge the difference to those who can afford it. But many or most would accept the lower fee for the poor elderly gladly if they were given back their freedom.
That is what happened before the ban on balance billing. The problem was never the lack of access by the poor to docs. It was the whining by the elderly upper middle class who felt put upon by balance billing. Even though poverty is not the universal or even normative condition for the elderly in America–where half the wealth is owned by those over 65.
That would be the solution that offers freedom, autonomy, fiscal responsibility, and which strengthens the doctor patient relationship on which good medical care rests. Instead we will either get more corporatism or more socialism–either leading to less autonomy, less freedom, less professionalism by doctors, and lower quality more impersonal healthcare.
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