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Doctors Opting Out of Medicare

Doctors Opting Out of MedicareWASHINGTON: One key factor ignored by politicians in the healthcare debate: physicians’ willingness to do what they are told. Politicians assume that doctors work for them, and will do whatever they are ordered. This is not a valid assumption.

Take for example Medicare. Many doctors decline to see Medicare patients, citing diminishing payments and the increasing burden of paperwork imposed by the government:

Many people, just as they become eligible for Medicare, discover that the insurance rug has been pulled out from under them. Some doctors — often internists but also gastroenterologists, gynecologists, psychiatrists and other specialists — are no longer accepting Medicare, either because they have opted out of the insurance system or they are not accepting new patients with Medicare coverage. The doctors’ reasons: reimbursement rates are too low and paperwork too much of a hassle. Julie Connelly, NY Times

This is not a new problem. For years doctors have been opting out of the Medicare system simply to preserve the profitability of their practice. If their practice can’t make a profit, then they can’t afford to take patients. Without doctors taking patients, no amount of government sponsored insurance will fix the system. More and more medical groups are expressing their frustration:

Some doctors say the [Medicare] program can be downright frustrating. They complain that it doesn’t pay enough, has burdensome rules and puts them under the threat of being audited by government agencies searching for fraud.

Because of those issues, “We decided that Medicare just wasn’t going to work for us,” says David Downs, an internist with the 50-member New West practice in Denver. “We were losing about $100 per patient per year among Medicare beneficiaries.” Julie Appleby, USA TODAY

If they will no longer see Medicare patients, what makes anyone think that they will want to serve patients on a new all-encompassing federal healthcare program? We will have the same problem with the expanded healthcare systems being considered, only worse. This comes as a doctor shortage already looms on the horizon:

The number of U.S. medical school students going into primary care has dropped 51.8% since 1997, according to the American Academy of Family Physicians (AAFP).

Considering it takes 10 to 11 years to educate a doctor, the drying up of the pipeline is a big concern to health-care experts. The AAFP is predicting a shortage of 40,000 family physicians in 2020, when the demand is expected to spike. The U.S. health care system has about 100,000 family physicians and will need 139,531 in 10 years. The current environment is attracting only half the number needed to meet the demand. Janice Lloyd, USA TODAY

Does anyone think Pelosi’s 2000 page monstrosity will help? What doctor is going to want to work for Pelosi? Is she planning forcing them to treat patients?

The healthcare debate is not an honest one. It is not really about fixing healthcare, it is about a mad grab for power by an administration desperate to cement its reach over as much of our economy as possible before the mid-term elections sweep out their majority.

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  1. Andrew (GWUMC 2013)
    November 4th, 2009 at 20:13 | #1

    There is an additional result of governmental price setting in health care: it directly influences the decisions medical students make when choosing a specialty. For example, until recently Ophthalmology was a very desirable specialty, but a few years ago cataract repair reimbursements were cut 33%. The result: no one in my class is even considering the field. A similar effect is being felt in primary care. Students have enough to worry about without the shadow of a governmental fist hanging over their future.

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