We are a commune of inquiring, skeptical, politically centrist, capitalist, anglophile, traditionalist New England Yankee humans, humanoids, and animals with many interests beyond and above politics. Each of us has had a high-school education (or GED), but all had ADD so didn't pay attention very well, especially the dogs. Each one of us does "try my best to be just like I am," and none of us enjoys working for others, including for Maggie, from whom we receive neither a nickel nor a dime. Freedom from nags, cranks, government, do-gooders, control-freaks and idiots is all that we ask for.
I opted out of Medicare years ago. I felt morally torn about doing so, but finally my bookkeeper refused to do any more of their paperwork. That settled it.
My compromise was to institute a generous sliding fee scale for Medicare-aged folks. (My general policy is to never decline a referred patient because of money.) From a young Doc, in the WSJ:
Here's something that has gotten lost in the drive to institute universal health insurance: Health insurance doesn't automatically lead to health care. And with more and more doctors dropping out of one insurance plan or another, especially government plans, there is no guarantee that you will be able to see a physician no matter what coverage you have.
Consider that the Medicare Payment Advisory Commission reported in 2008 that 28% of Medicare beneficiaries looking for a primary care physician had trouble finding one, up from 24% the year before. The reasons are clear: A 2008 survey by the Texas Medical Association, for example, found that only 38% of primary-care doctors in Texas took new Medicare patients. The statistics are similar in New York state, where I practice medicine.
More and more of my fellow doctors are turning away Medicare patients because of the diminished reimbursements and the growing delay in payments.
Excellent. I fully intend to continue buying high-deductible private insurance for myself until I die, or else to self-insure for medical costs though the quaint old practice of using my savings. So there's only one thing that really scares me about Medicare, which otherwise would be irrelevant to me. It's the worry that non-Medicare insurance will be legally unavailable to me once I'm 65. In that case, I'd really like to know that there still will be doctors out there who will be willing to treat me for cash. The more doctors who withdraw from Medicare, the happier I'll be, because their practices won't be distorted and ruined by the crazy restrictions that Medicare puts on them.
I was recently in the West Indies at dinner with people from many countries, and a woman from England was talking about how relieved she was to finally be getting her "condition" taken care of. She said she went private, because, "you know how you have to go private." I had no idea what she was talking about. Apparently, when the health system is paid for by the government, you still have to pay for your health care if you want any. Meanwhile, I hear liberals commenting all the time here in the US that it will be so much better when they can finally stop dealing with their insurance company when the government institutes national health insurance.
OK, here's an irreverent, heretical, and dangerous thought...Maybe national health care with the private option isn't such a bad idea. Hear me out on this...Just like what the school system has devolved to in the larger cities, all of the losers go with the government system and people who give a damn go private. The rabble are too stupid to understand what a crappy deal their getting anyway. Yes, the rest of us have to pay for it. But when you consider all the bureaucratic BS you have to go through with your own insurance company that only exists because these morons who try to cheat and scam are a part of our existing systems. Government health care would provide a nice little pig pen to contain these idiots and they wont track their moronic schemes into the private system. Hell, we're already paying for their crap anyway, why put up with the BS that goes with them?
There are two sides to this story. There are plenty of physicians who pad bills to Medicare. Some justify it by saying they won't get paid what they're worth, but enough don't bother justifying it because they know Medicare will pay. To some, Medicare is a gold mine; to others, something of a moral dilemma best left up to lazy bookkeepers to decide.
With coverage in the New York Times and Wall Street Journal recently, the Texas Medical Association’s survey of primary care physicians’ reluctance to take new Medicare patients is getting lots of play. Certainly the economic and administrative hassle factors are there and make a big impact on physicians trying to keep open their practice.
What has been omitted, though, is the other major finding from our survey: Texas physicians will not refuse their current Medicare patients. Nearly 70 percent say that is something they will not do. Fewer than five percent say that is something they have done or will do.
As a family medicine specialist from Dallas said in response to our survey: “I will continue to provide care to my existing Medicare patients as a courtesy to them, but I will soon be closing my panel to new Medicare patients, because not doing so will jeopardize my ability to provide care to everyone else.”
Texas Medical Association