Medicare doesn't pay enough today
A vigorous 75-year-old man was airlifted to the emergency room recently for treatment of a heart attack. After evaluating him and making arrangements for his probable angioplasty, I stopped to talk with his family. To my surprise, the patient's son concluded our discussion by expressing sympathy for me. He was concerned about the impact on my profession of managed care and insurance impositions.
Frankly, I was pleased to hear that he had heard about the problems the health care system has been having, but at my core I did not feel that his sympathy was warranted. Here I was, with a patient, making a difference. This is what I trained for and love.
When things go well and my patients respond to treatment, I feel like Roy Campanella, the splendid catcher for the Brooklyn Dodgers of the'50s, when he said: "I'm still amazed that they're willing to pay me to play this game." But the landlord for my office building does not feel that way. He wants the rent paid. The secretaries and nurses in my office need their pay. The malpractice carriers have increased my premiums by 50 percent this year. And my own health insurance rates have increased along with everyone else's.
So it is significant that Medicare reduced overall physician reimbursement rates by 5.4 percent this past January, under a formula approved by Congress. Prior to this, Medicare reimbursement rates had been static for years.
The inevitable is now happening. The New York Times reported last month that "for the first time, significant numbers of doctors are refusing to take new Medicare patients, saying the government now pays them too little to cover the costs of caring for the elderly." Further cuts in the Medicare fee schedule are planned for the next few years.
We all know that the HMOs have been leaving the Medicare HMO program in droves because of inadequate funding. And hospitals, struggling with marginal compensation, have been closing. Those that survive have been hiring minimal nursing staffs and have been reporting significant errors in providing care. Working on call on a recent weekend in New Haven, I found that one hospital had no intravenous hydrochlorothiazide, a standard diuretic. The other hospital across town had no intravenous furosemide, an even more widely used medication for coaxing urine output from patients with heart and/or kidney failure. Both blamed national shortages of standard generic drugs for the problem.
Is anyone listening? Our health care system, a source of national pride in the past, is eroding. The social compact made with our senior citizens through the Medicare program is being compromised.
How has the Bush administration responded? Health and Human Services Secretary Tommy Thompson has suggested that Congress find the money to reimburse doctors adequately from dollars allocated to other "providers" in the Medicare program.
What is he saying? That there is so much money in the Medicare budget that it just needs to be redistributed? Then why are the insurers leaving? Why are doctors reluctant to see new Medicare patients? Why are hospitals struggling?
A better translation of Secretary Thompson's response: "Let them eat cake."