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Susan Estrich
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The Doctor Is Not In

Comment

Not long ago, a close friend called me with an unusual request. She and her husband were looking for a new doctor to take care of them. What made it unusual was that they'd had the same doctor for years — decades, actually.

What happened to "J," I asked. Did I miss something in my otherwise careful reading of the obits? Had he hung up his stethoscope?

None of the above. Her husband had turned 65 and was now eligible for Medicare. Good news — except "J" is one of the increasing number of doctors who aren't taking "new" Medicare patients, or even old ones.

I remember the days when the health insurance industry used to advertise that Hillary Clinton would take your doctor away. She didn't. But a lot of people have lost their doctors anyway because of the PPO rules and, lately, because doctors just don't want to put up with the rates Medicare pays.

According to the Centers for Medicare and Medicaid Services, 97 percent of the doctors in America accept Medicare. But that is a very deceptive number. It doesn't mean that doctors will take new Medicare patients. According to another study, this one by the American Medical Association, 17 percent of the doctors they surveyed restrict the number of Medicare patients in their practices — and that number for primary care physicians is 31 percent. Watch out!

Some doctors get around the Medicare limits by charging for "concierge" service. I kid you not. They charge an upfront fee for doing things like promptly returning your calls and providing top-notch referrals, things my own doctor (not a concierge) calls good medicine. Others just get rid of longtime patients when they turn 65.

In an era of double-digit unemployment, it's hard to feel sorry for people making six-figure incomes.

On the other hand, many people who do work of lesser value — that required much less education — make far more.

I was looking at a hospital bill of my own (from when I collapsed on a street corner in New York City), and frankly, I was pretty horrified to discover that the doctor who read my brain scan and concluded that, thank God, there was no mass was paid less than the hairdresser who trims my hair. Don't get me wrong: I like my hairdresser and value his work. But my life doesn't depend on it.

And the doctor got more from my insurance company than he or she would have received from Medicare. I have private insurance. Doctors get paid, on average, 22 percent less from Medicare than they do from private carriers. And they're prohibited by law from billing you the difference.

Obviously, we need to do something — actually, many things — to rein in the skyrocketing costs of health care. As more of us get older and the number of uninsured decreases, those costs are only going to increase. But simply paying doctors less to do their jobs is not the answer.

Better prevention, better screening, fewer unnecessary tests and procedures, more coordination — all of those are important steps. But there is something wrong when people like my friends reach their 60s and have to find new doctors because the ones who know them best won't take care of them anymore.

I told my friend to call my doctor, Larry. He's watching his income being slashed, but he's past caring. He is what another doctor friend of mine calls a "dinosaur" — a doctor who puts patients first, even at his own expense, which is how things work today. I am grateful to have a dinosaur on my side. But I fear that his ilk is facing extinction, and we will all suffer for it.

To find out more about Susan Estrich and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate website at www.creators.com.

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Comments

19 Comments | Post Comment
Obamacare really does have death panels.
Comment: #1
Posted by: David Henricks
Fri Jun 25, 2010 12:29 AM
Who ever said medicare and Obamacare was good for the country? Answer - the liberals like Susan. Now we begin to pay the real price - less care. My son is a urologist. He puts in over 12 hours a day caring for his patients and is on call the rest of the day. He has a small business to run with equipment to purchase, payrolls to meet and anti-lawyer insurance to pay. It cost him a small fortune to get the degree and the training. He does pro-bono but may have to reject medicare patients to keep his so called 6 figure income which he refuses to redistribute.
Comment: #2
Posted by: Early
Fri Jun 25, 2010 5:36 AM
The system America calls "healthcare" works for so few individuals (mainly insurance comp CEOs) and abuses almost all of the rest of the us. Doctors should not have to practice with so little compensation and patients should not have to suffer with the mind-boggling quagmire of being insured vs. being uninsured and bankrupt. A country full of such brilliant individuals, why can't we do better for ourselves?
Comment: #3
Posted by: Aurora MacGregor
Fri Jun 25, 2010 10:09 AM
The only thing insurance guarantees is you pay every month (or quarter, or year). Insurance bleeds the system at every level but doesn't provide value for the money.

The government and media would have you believe health care insurance and health care are the same thing, and this is the main reason costs are skyrocketing. Medicare is health care insurance, not health care. Doctors run from Medicare not merely because of diminishing reimbursement, but because Medicare rules and red tape are so impossibly cumbersome, irrelevant, and time consuming that no one has the time for that and spending time with patients, too.

The time costs of Medicare and other insurance far outweigh the benefits of reimbursement. Because of insurance and government regulation, most health care professionals spend more time treating charts and records than seeing patients, because the insurance companies and government have assumed the task of collecting before the problem exists and controlling payment when problems do arise.



Comment: #4
Posted by: Katharine C. Otto, MD
Fri Jun 25, 2010 11:18 AM
dear susan estrich:
is this column about what lawyers call "buyers remorse?"
don_in_central_jersey
Comment: #5
Posted by: don_in_central_jersey
Fri Jun 25, 2010 12:11 PM
During the health care debates I used to yell at the TV set everytime Obama said, "under my plan you'll be able to keep your same doctor". Basically what I said is, "You're a lying sack of ....", because I knew damn well that many Doctors would be running, not walking away from Medicare. Obama knew that too. This bill is a diaster and things will only get worse as it evovlves. There were many things that could and should have been done in incremental steps, not a giant overhaul that no one understands.
Tell your friends, that's what you get for voting for an extreme liberal.
Those of us who don't have your high income, for better or worse are stuck with Medicare. Glad you can afford private insurance, I sure as hell can't. In adition, the new bill will either close down or increase dramatically the cost of Medicare advantage. Without Medicare Advantage I'll be looking for a Doctor in some third world country.
Comment: #6
Posted by: David Kidd
Fri Jun 25, 2010 4:34 PM
Obama, Reid and Pelosi knew that they couldn't get a single payer system in 2010. So they created Obamacare to ruin the delivery system for medicine so that the only alternative to a totally broken system would be for the government to step in. This was completely predictable. Expect to hear horror stories around prescription medicine, medical supplies, long waits for routine appointments, lost lives during diagnostic delays. This is all acceptable tragedy to the Obamacons to get their long-term goal: government run medicine, manufacturing, banking, energy. Wake up, Susan; you and your liberal friends are responsible for the horrors that await this country.
Comment: #7
Posted by: Lesley Barnard
Sat Jun 26, 2010 9:36 AM
There's so much in this piece to talk about, and it's refreshing to see someone detailing some of the problems without carrying a huge 2X4 on her shoulder. The problems are real; the solutions complicated, if even possible.

I'd like to say iirst, however, that Hillary Clinto didn't take away anyone's doctor ONLY because she didn't have the chance. Her plan would even have taken away the choice to pay someone to get treatment outside of the plan. Naturally, wealthy people like Hillary could have gone outside the country for treatment, but the "little people" would have been stuck.

It's true that many doctors will choose to avoid Medicare patients (until this administration creates a quota system of some sort), but it's not just because of the meager payments by Medicare; it's the inefficiencies. It's one thing to be paid a big chunk less for providing service, but to not even get the payment in a reasonable time adds to the disillusionment. Meantime, there are employees and rent or mortgages to be paid. Ask any doctor who is more reasonable to deal with --- insurance companies or the government. People don't realize how charming it will be when the government IS the insurance carrier: much more restrictive patient care, and slower and more and more meager payments to doctors. Not what I'd call better healthcare.

I'm happy that Ms Estrich has a dinosaur for a doctor. I'm sure he's older and more able to absorb the reduced income. This is fine for him. But many doctors are young and have huge financial burdens from undergraduate college and medical school , not to mention new mortgages and young families. And did I mention exorbitant malpractice insurance? They have also not been working for 9 or 10 years since undergraduate school, so they come to the working world a decade later than others. Their six-figure incomes are usually on the low side, and after high taxes and huge debts, they are not rich. The average physician, in fact, makes far less money than most people think.

It would be wonderful to figure out how to reduce medical costs, but the usual suggestions don't do it. While it is wise to screen and to seek preventive care, as they may prolong and enhance the quality of life, they do not reduce the cost of medical care. In fact, they increase the costs. Check all the studies on this.

Something else to keep in mind is that a medical practice employs dozens people besides the treating physician.
The doctor's fee pays not just for the doctor, but for all these people as well.



Comment: #8
Posted by: Laurs1
Sat Jun 26, 2010 10:00 AM
I think its important to note that Obamacare is not the cause of Medicare not paying doctor's adequately. This has been going on at least since President' Bush Srs administration and probably before then. . . I only became aware of it during that timeframe because a family member was impacted.

To the best of my knowledge, there is nothing in the healthplan that address the discrepancy in payments.

Its my perception that if Medicare fraud were better controlled than perhaps those funds could be used towards increasing payments.

Any thoughts?
Comment: #9
Posted by: capiscan
Sat Jun 26, 2010 10:40 AM
Welcome to the real world Ms Estrich---The new "medical care" legislation--so eloquintly lied about by politicians and praised by liberal dreamers who have no experience in the practice of medicine---has become law of the land and now you too will get a chance receive care under its rules. As a former dinosaur, I must confess that my wife and I ran a small business in this country---a medical practice--and by having two physicians and a small office staff, we made a living, but in all honesty if my wife hadn't continued to practice, I could not have continued to run the practice as my earnings would have been completely used to pay for the cost ot the business--thus no take home earnings at all. The added harassment and constant downgrading of payments by medicare intermediaries added to the negative atmosphere of private practice. We are now retired and miss our patients and their families, but not the current practice of medicine. Be prepared---your medical care in the future will be streamlined---you will receive medical care through groups of physicians--not your doctor, but a group of doctors who rotate--work on shifts--are largely supported by non-M D assistants---will see patients once a day. It's a new world, Ms Estrich---My wife and I feel that we are fairly well set for the future of medical care, having children in the medical field, including one who is a director of a Medicine residency training program at a state Medical School--I would hope that your future is as well-planned. Enjoy 21st century medicine in the U S A.
Grump M D---retired
Comment: #10
Posted by: Grump M D
Sat Jun 26, 2010 12:45 PM
Are you reading the comments, dear Susan.
Perhaps Susan should change her last name to Ostrich. It is apparent she buried her head in the sand when we debated the Obama "Let's Kill American HealthCare Standards and Cram It Down Your Throat" Act of 2009.
There will be more concierge services and less doctors taking "gummint" healthcare because the reimbursement rate will dwindle farther and faster, just as it has in the UK and Canada.
But, Susan bought into this, bless her little heart, and championed the future destruction of HEALTH CARE in this country ...but at least we will all have health care INSURANCE, right?
Comment: #11
Posted by: RW
Sun Jun 27, 2010 12:15 AM
My Dear Susan,

Do not take it so hard that cold hard facts are starting to sink in on the Obamacare. It will only get better as the 40% tax on the medical industry kicks in and the doctors pay package reduced even further by the panels to be assembled in Washington DC. The UK with their medical program already has the so called Death Panels refusing medicine to people past a certan age as it just costs too much. Canada is not far behind. America will have these starting in 2012 right after the elections are over as all of the bill contains parts that start kicking in after the elections of 2010 and 2012. This was the Liberal Dream Package that will become the Liberal Horror Package for the American people. What I found so funny is that the Democrats when asked to limit tort claims they refused stating they could not take on the trial lawyers - big contribitors to the Democrat party along with the Wall Street bankers proven by facts and figures. We can all look forward to less health care and more pills to relieve the pain just as Obama stated on national TV.
Comment: #12
Posted by: Gene44
Sun Jun 27, 2010 12:23 PM
This is a little off from your point...
You mention the cost of your trip to the hospital. Our hospitals cover anyone - insured or not. Those undocumented workers and young people for example - go to the hospital and skip out on the bill. You and your insurance company get the pleasure of paying more to compensate for those who do not pay. That doctor's bill you paid is covering the money he did not get from the 3 people he saw prior to you.
I believe in everyone being treated. However, there should be at least some attempt to collect the money. I know at my hospital there are signs only written in Spanish (that I can figure out) that say not to worry - your service will be paid. When I got bills totalling $2,000 for 3 xrays and 15 minutes in the ER - my insurance company paid almost half (which I feel was generous since it shouldn't have cost that much). I had to pay the other half. I was hunted down to pay that other half.
This new healthcare bill does nothing to fix this problem. I am insured. I still paid $1,000 for 3 xrays. If it is always going to be acceptable that if you are of a certain age or undocumented that you don't have to pay a single dollar - then it will never change. I'm all for being a country that makes sure nobody is dying on the street. However, I do not believe it fair that someone uses the ER (especially non-emergencies) and is not even asked for a dollar.
You can yell and scream at insurance companies being evil-doers. I, however, find it silly they should cover bills that are clearly ridiculous. If I were an insurance company I wouldn't pay $20 for a single aspirin. Nobody fixed the problem - and reduced the cost of a service. This was a ruse to get to a single payer option and not get to the hert of the problem. Don't be naive.
Comment: #13
Posted by: Lisa
Mon Jun 28, 2010 6:17 AM
Susan, I can not believe you even wrote this column. You of all people know what lies a head for all of us with health care voted on and passed with much bribary and threats to our politicians who saw the truth. Shame on you!!
Comment: #14
Posted by: Kathaleen
Mon Jun 28, 2010 9:26 AM
Suzie, "First we kill all the lawyers."
Comment: #15
Posted by: Paul
Tue Jun 29, 2010 8:57 AM
Susan are you purposely setting yourself up with this? You liberals/socialists will have to reap what you've sowed. Government is not the answer, it is the problem! It's just ashame that the rest of us will also have to suffer because of your stupidity. November may well be our last chance to save this once great country from the liberal poison that has infested "education" and the "government run media."
Comment: #16
Posted by: rinohunter
Tue Jun 29, 2010 1:51 PM
I rarely agree with Susan but have certainly enjoyed Susan's past few columns. With each article the left must be waiting for, in their view, Susan's next foot in mouth moment, while Susan slowly but seemingly unknowingly comes to grips with the reality of the lunacy of the amateur hour Obama administration, its policies, its so called successes, its inexperience, its incompetence, its lies and the destructive effect on all Americans. It is said that she who knows not but knows not that she knows not is a fool, that she who knows not but knows that she knows not is teachable and she who knows not that she knows is asleep. Seems that Susan has been asleep for many years but is slowly awakening to the One Big Ass Mistake America made. Buyer's remorse clearly setting in.
Comment: #17
Posted by: joseph wright
Tue Jun 29, 2010 2:00 PM
Thank you for your article.
My personal experience with Doctors accepting Mediacare for payment is much worst then you suggest. I'm having a very hard time finding a Doctor that accepts Mediacare now that mine no longer does. I have been with this same Doctor for over twenty-five years.
Additionally, I have found many Doctors and health facilities no longer accepting Mediacare or CASH. Mayo is one.
This situation will only get worse when more people come to rely government sponsored insurance and traditional insurance is squeezed out of existences.
Comment: #18
Posted by: Bill Hopfer
Mon Jul 5, 2010 11:01 AM
If greedy doctors want to play dirty, it's time patients organized and fought back. AARP should publish a listing online, updated daily, of all doctors who drop patients when they go on Medicare or refuse to take new Medicae patients. Local AARP members could then spread the word to their younger family and friends to change doctors now to one that respects his/her elder patients. Employees in group plans should organize to force their employers to drop from their PPOs any local doctor that is found to be dropping or freezing Medicare patients. Why pay into a plan when you're 30, 40, 50 and 60 that supports doctors who will kick you out the backdoor when you turn 65? Doctors depend on group insurance for their profit. Hit 'em where it hurts.
Comment: #19
Posted by: Laurie Craw
Mon Jul 5, 2010 8:00 PM
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