Medicare battle likely to continueBy Jill Coley (Contact)
The Post and Courier
Sunday, July 13, 2008
Grace Beahm Dr. Stewart Eads dispenses prescriptions to Medicare patient Martha Knight at his West Ashley office. Eads, an internist, said that if the 10.6 percent cut in payments to physicians becomes law, he will have to refuse new Medicare patients. 
Grace Beahm Eads said that even if the payment cut fails to become law, the fact that reimbursement increases have been stagnant for nearly a decade puts pressure on physicians to weigh the option of opting out of Medicare. For nearly a decade, the story has been the same. In December, Congress threatens to cut Medicare. But before the new year begins, legislators stave off slashing the nation's insurance program for the elderly. This year was different. The funding debate was postponed until July. Lawmakers missed that deadline, and a 10.6 percent cut to physicians went into effect. As a stopgap measure, the government stopped processing Medicare claims until enough senators voted July 9 to block the cut. Area doctors are left feeling battered. Dr. Stewart Eads, a West Ashley internist, said, "It is likely we will be right back in the same situation in late 2009, just as we have this year and in countless years past, trying to head off disaster at the last second." Dr. Marshall Newton, a primary care physician in West Ashley, said that as long as doctors don't complain and continue to offer the same care, few patients are likely to notice the unsteady ground on which Medicare stands. "We have to get the word out to the public," he said Some patients took note of this year's funding battle. Fred Day, 71, has Medicare supplemental insurance and is a quadriplegic who relies on seven doctors. An auto accident 50 years ago broke his neck. "I don't know what in the world I would do if my doctors say I 'couldn't help you anymore,'" Day said. "How can they afford to look after people if they're not getting paid?" A former state representative, Day said watching the politicians toss the Medicare hot potato got him fired up. "I cannot understand how this crowd in Washington let it get to this point," Day said. President Bush vowed to veto the bill because the money to pay doctors would come from reducing payments to insurance companies that offer private Medicare plans, which are alternatives to traditional fee-for-service Medicare. The bill to block the cut in physician pay passed the House overwhelmingly, 355 to 59, and also cleared the Senate with a veto-proof margin. South Carolina Sens. Jim DeMint and Lindsey Graham, both Republicans, voted against the bill. "This bill ... is a deliberate attempt to move Americans away from private insurers and into socialized medicine," DeMint said Dr. Richard Schmitt, president of the South Carolina Medical Association, said that while the American Medical Association supports market-based solutions, "This is punishing seniors and physicians also." Even if Bush's promised veto fails, which appears likely, the issue is going to come back because the formula used to reimburse physicians is faulty, Schmitt said. While other entities, such as hospitals and nursing homes, receive 4 percent to 8 percent increases annually, doctors' reimbursement is exponentially reduced each year. "Legislators are ignoring a flawed formula," he said. If that core problem is not corrected, doctors will face a 20 percent cut in 2010. What's left physicians so flabbergasted is that they're not even asking for a pay increase, Eads said. "We're talking about holding steady, and that in any business is a loss mode," he said. Physicians' Medicare reimbursement has remained basically unchanged since 2001. During that same period, overhead costs have increased 40 percent, Schmitt said. Those factors dwarf the .5 percent pay increase that was included in the July 9 bill. Patients who have paid into the system during their careers often are shocked to learn doctors take a 30 percent loss in pay for each Medicare patient they see, Newton said. Day was surprised to learn physicians' pay has not changed in years. "Congress has pay increases automatically each year," he said. This year's standoff had doctors weighing their options. DoctorsManagement, a Knoxville, Tenn.-based medical consulting firm, received a spike in calls from doctors across the country asking how to opt out of Medicare. Many physicians also called about the two-week freeze in claims, which affected cash flow. "We haven't done many of those medical analyses for many years," said Bill Bristow, a partner of DoctorsManagement. "We're resurrecting that." The decision to drop Medicare is not easy for physicians. "We're going to get logical and emotional responses to this," Bristow said. Two members of the S.C. Medical Association's leadership already have discontinued their Medicare participation, Schmitt said. He described the situation as a "perfect storm." As doctors are weighing staying in Medicare, the largest population of seniors in history, baby boomers, are aging into the system. About 700,000 South Carolina residents, or about 16 percent of the state's population, receive Medicare, according to the Lt. Governor's Office on Aging. The first of South Carolina's 1.3 million baby boomers will turn 65 during the next president's term. "It is a very real, very scary issue," Schmitt said. Reach Jill Coley at 937-5719 or jcoley@postandcourier.com. |
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Comments
This article has 6 comment(s)
Posted by JoshuasGrandma on July 13, 2008 at 6:15 a.m. (Suggest removal)
Did you know that, "[t] he U.S. spends a greater portion of gross domestic product on health care than any other industrialized country in the world but is the only industrialized national that does not have a unified national health care plan"? (National Coalition on Health Care; June, 2005)
Did you know that despite the U.S. spending a greater portion of gross domestic product on health care than any other industrialized country, it "ranks 37 out of 191 countries according to its performance"? (World Health Organization; June 21, 2000)
Did you know that, "About 18,000 unnecessary deaths occur each year due to lack of health insurance"? (National Coalition on Health Care; July, 2008)
Did you know that, "More than two-thirds of adults and one-third of children in America are obese or at risk for obesity"? (Robert Wood Johnson Foundation; July, 2008)
Did you know that, "[t]he percentage of people with employment-based health insurance has dropped from 70 percent in 1987 to 59 percent in 2006"? (National Coalition on Health Care; July, 2008)
Much of health care cost increases stem from huge administrative overheads - a single payer system is the only answer!
Posted by LadyRenegade on July 13, 2008 at 7:48 a.m. (Suggest removal)
Everyone's first bandwagon is to look to Canada as an example. Yet people don't realize that if you need an operation, say surgery on your leg, you're in a wheel chair but if you had the surgery you'd be up and walking. Tough. Get in line. Maybe sometime next year you'll get a call. Until then, take these cheap pills and the Doctor will see you as soon as he can get to you.
For those who have served in the military to retirement and think they can just blow by this story, think again, Tricare often follows Medicare's example. This is an unfortunate fact I know from experience.
Posted by majorjohnson on July 13, 2008 at 9:46 a.m. (Suggest removal)
Did you know that the National Coalition on Health Care is primarily there to support single payer health care? Did you know that they will do and say anything to further their cause?
I think it's odd that a doctor would be such an advocate of me doing without some of my money so that he can be paid to do his job, but he won't do without some of his money to do it. His giving a discount to provide the service at cost or even at a loss is not fair, me working a few hours and giving him the money to pay for someone elses health care is fair.
As far as cost, that's partially because the government is involved at all, as that always pushes the price of anything higher. Part of it is because we have the equipment...here you can get a CAT scan within the week, sometimes even same day. CAT scan equipment is everywhere. Go to Canada and there are a handfull of CAT scan machines scattered about, you get put on a list and have to travel who knows where when your turn is up. You can be on a wait list for up to 12 weeks for a CAT scan in Winnipeg. You can see wait times by province/care center/procedure here http://canadaonline.about.com/od/healthc...
How about a 20 week wait list for hip replacement? 26 weeks for knee replacement. 180 days for a hysterectomy. 180 days for cataract surgery. 332 days for pediatric dental/oral surgery. But it's free...except the tax rate in Canada is huge (http://www.cra-arc.gc.ca/tx/ndvdls/fq/tx...) and the medical payment system is still going broke. The father of the Canadian health care system (Thomas C. Douglas) now admits that it has been a failure and is advocating a move back to private care.
Posted by RW on July 13, 2008 at 4:54 p.m. (Suggest removal)
None of this is a problem. That is..free market reforms can fix these things. You want problems? Socialized Medicine! It would be catastrophe like it is all over the world! Ask anyone from Canada, France or Great Britain if they like their system. Unless they are a socialist they will scream.."Hell No!"Uncle Teddy from Mass could not have jumped in front of the line to get his most recent brain surgery {under socialized medicine. Well any rich leftist would} He would have had to wait six months. It's funny though the libs that want socialized medicine no way in hell would wait for services. They would all go private hospitals. No..the Govt hospitals would be for everyone else. Which candidates want this failed system... that's right the democrats! Of course they know the system does not work they only want the control that it brings the Federal Govt. Please libs,,do not post that socialized medicine works..you'll embarass yourself!
Posted by FiscalConservative on July 13, 2008 at 8:42 p.m. (Suggest removal)
Excactly Lady renegade. I tore my patellar tendon off recently. I was on a website message board for people who had this surgery to find out what lies ahead and talked to a man in Canada who had to wait 2 MONTHS for his surgery. I had to wait 3 DAYS. God Bless America. This is a major surgery of the knee with about a year to full recovery. I could not imagine having to wait two months for that surgery. The two months in the brace after the surgery were terrible.
Posted by deardurk on July 15, 2008 at 9:13 a.m. (Suggest removal)
A simplified definition of Democratic Socialism: It doesn't matter if the program works as long as everyone is in the program.