04
Jul
08

Medical Meltdown

This post will not go well. I do not believe in socialized or nationalized medicine. I do not believe that some political wonk gets to decide:

  1. What procedures my doctor can and cannot treat me with
  2. What medicines I can and cannot take
  3. How long I have to wait to get treated
  4. Whether my condition warrants treatment at all
  5. What my doctor can and cannot charge

HMO’s, PPO’s, and Medicare are already semi-solid versions of this “manage medicine to the middle” approach and the cracks are beginning to enlarge. Health care is not a right. People get hurt and people die, regardless of income or economic strata. And medicine has always had a relatively high cost associated with its practice. Back in the day, it might have cost you two goats, a sheep, and your daughter to get your son’s infected leg treated. Pretty steep. And it’s steep today. And getting higher. Getting trained is expensive. Medical equipment is expensive, pills are expensive, insurance against the yahoo who’s gonna sue you into oblivion for malpractice is expensive. Is normalizing these costs so that everyon gets mediocre care the right idea? No. Just have a look at how the market dynamics are working.

HMO’s provide a way for doctors to “get into the game”. See a lot of patients, accept a specific, noramlized fee, don’t get outside the lines, and woe be unto the patient that needs something outside the scope of the plan. Patients have little latitude and hope they get fixed. PPO’s are a step or two up the ladder. The programs cost a bit more via premiums and the patients have a little more say in what goes on. The services are still provided for at a contract amount (which is higher than HMO rates). Medicare is the government version of an HMO for specific groups of US citizens. Physician migration takes place across the spectrum of care. By migration, I mean that doctors actually make a choice. Doctors that practice in nationalized countries often come to a point where they must choose between a proscribed practice or exodous to another country where the market can set their value based upon their skills. The doctors of Canada, China, India and more… many choose to develop their practice instead of stagnate it in mediocrity. And the doctors of the US do the same thing. Many who truly excel are working their way up the ladder of insured medical structure. They toil in the HMO, slide to the PPO and then many opt out of all of the assigned fee programs all together. And then there’s Medicare. Everyone knows that the cost of medicine is going up. What is the government funded response to Medicare? Reduce the fees that doctors can charge for their services. The US Congress returns from a Fourth of July recess Monday needing a short-term fix just to avert a 10.6 percent reimbursement cut scheduled to go into effect July 15. That’s right, the cost of everything is going up along with the costs of medicine and Medicare wants to tell doctors that they have to take less. Doctors are choosing. In Texas, doctors are bailing out.

Only 58 percent of doctors in the state now accept new Medicare patients, according to a recent survey by the Texas Medical Association, down from an estimated 90 percent before 1990. Among primary-care doctors, the percentage is 38 percent. It is accelerating.

For the elderly and low-income patients, it’s going to mean long lines and even more mediocre care at fewer facilities. So, what is the solution? More importantly, is this something that government should be involved in?

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3 Responses to “Medical Meltdown”


  1. July 4, 2008 at 8:05 pm

    Of course, I don’t have any answers, but I do have a few observations.

    My son is physically disabled and regardless the supposed goodness of ADA, it is becoming harder and harder for him to find employment, especially the kind that comes with insurance coverage. Fortunately, he has Medicare. He used to also have Medicaid as a secondary insurer, but even his Social Security Disability income is over the limit for medicaid coverage (at least in TX, LA, AR, OK).

    Right now, he can’t find a primary doctor to accept him as a patient. We’re still looking, but that’s tiring too. He has had to go the route of using the ER for primary care. That’s not good on many levels, for either him or the system.

    My husband is on Medicare, but fortunately has Tricare as a secondary insurance. He’s also fortunate to have been seeing the same primary doctor for over 10 years. His concern is that this doctor isn’t much younger and will be considering retirement soon. Who then? hmm… good question.

    The thing that outrages me is that we have no choice. When he retired, he lost his medical coverage because he was eligible for Medicare. I’m still on Tricare, until I turn 65. Not that his retirement checks (thank goodness we don’t have to live on only one of them!) would allow us to buy insurance to replace Medicare, even if it were available.

    What’s an old person to do these days? It makes sense to me that doctors are getting out of the system, it’s just that I don’t see where I have that choice. I can’t deny that scares me a bit.

  2. July 5, 2008 at 7:35 am

    I really don’t know what *the* answer is. I see more and more doctors’ offices with signs that say “We do not accept Medicare”. I see more and more employers offer access to medical insurance (at an astronomical rate) as opposed to offering the coverage.

    And I find the whole concept of medical insurance as an economic enigma. People want some company to pay out more money than they take in. It’s not a tenable business model. And government wants to take over this arena. Sounds perfect.


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