There’s lots of talk about primary care doctors threatening to refuse Medicare and Medicaid patients. As some commenters point out, “If you don’t like the system, just drop out.”
Why, then, do so many doctors continue to see patients on Medicare and Medicaid?
Two words. Duty and conscience.
Primary care doctor Rob Lamberts has an excellent post on this, entitled, Good conscience is bad business. He notes how Medicare (and Medicaid, in particular) grievously underpays primary care, to the point where many of its recipients have trouble finding a regular doctor.
And indeed, his life would be made immeasurably if he stopped taking insurance:
If I dropped insurance and charged a fixed amount, I could:
1. Cut my billing staff nearly to zero (someone would still have to do bookkeeping).
2. Increase my payment per visit, which would allow me to see less patients per day.
3. Document for the sake of patient care, and not for the sake of getting paid.
4. Add extra services like email access and house calls without worrying about how I would get paid.In short, I could make my life better, my hassle less, and improve the quality of the care I offer.
But it’s his duty to his patients that prevents him from doing so. Calling caring for Medicare and Medicaid patients a social responsibility, he writes, “These people need to be seen and they deserve good care, and despite the hassle and drain on income they cause, I make a reasonable income. So far.”
Medicare and Medicaid exercises poor decision-making to starve primary care and rely on the goodwill and conscience of physicians to keep caring for its beneficiaries. That’s because physicians like Dr. Rob will increasingly be few and far between.
