Will reforming Medicare fees keep doctors in the program? No: More doctors are needed instead
12/25/2011 12:00 AM
12/23/2011 5:27 PM
The latest scare tactic by right-wing opponents of the Affordable Care Act aims at convincing Americans that reasonable trims in Medicare spending will make it very difficult for seniors to find a good doctor in coming years.
A lot of this hooey is based on an outdated 2008 report from the Medicare Payments Advisory Commission that 29 percent of the Medicare beneficiaries who were looking for a primary care doctor had a problem finding one to treat them, up from 24 percent the year before.
Please note that the report by the independent federal panel that advises Congress on Medicare was issued the year before the House and Senate passed the Affordable Health Care and made it the crowning achievement of President Barack Obama's first term.
There's no doubt that some doctors are leaving Medicare, but many do so in order to band together to form small concierge clinics that cater to wealthy seniors. These posh clinics are designed to cater to the top 1 percent of the nation's elderly — the ones who can pay boutique prices and prefer not to sit next to the riff-raff in germ-filled waiting rooms.
There's no doubt some physicians are leaving the Medicare system, but they hardly constitute the mass exodus that free-market advocates imply.
A survey reported in the June 27 Archives of Internal Medicine found that physician acceptance of new Medicare patients fell to 92.9 percent in 2008 from 95.5 percent in 2005, while more recent survey in early October by the Texas Medical Association reported 3 percent of its members withdrew from the federal program.
If there are serious doctor shortages looming in our future, they are more likely attributable to the rapid growth of people over 65 rather than a flight of health-care providers.
Some 40 million Americans have Medicare insurance, but they will be joined soon by 70 million baby boomers. The United States needs to increase significantly the ranks of its medical school graduates or begin to import more from abroad.
As for the doctors who would rather ignore their Hippocratic oaths to serve the poor as well as the rich, they will evoke few cries of pity from most Americans. While the proposed cuts in Medicare payments would cut a few percentage points from their income, they are hardly bound for the poor house.
American physicians across all categories make far more than their counterparts in any other country including such affluent ones as Germany, Japan, Britain, France, Denmark and Sweden.
Consider the median salaries as recently catalogued by the American Medical Group Association, which has been tracking the salaries of U.S. physicians since 1986.
They range from $204,000 for practitioners of family medicine to $605,953 for orthopedic surgeons who specialize in joint replacements. In between are anesthesiologists at $370,500, dermatologists at $375,176, gastroenterologists at $405,000, and radiation therapists at $447,250.
Bear in the mind that those are median salaries with half of all doctors making more and half making less. By comparison, the median household income in the United States is $46,623.
The fact that a relative handful of doctors are quibbling about slight cutbacks to their incomes at a time when 20 million Americans are unemployed or underemployed can be laid at the doorsteps of President Barack Obama, Senate Majority Leader Harry Reid and former House Speaker Nancy Pelosi.
Instead a of pushing for a low-cost, single-payer health-care system when Democrats controlled Congress in 2009, the trio couldn't forgo millions of dollars in campaign contributions from Big Pharma, Big Insurance and powerful physician groups.
If they had, Americans might now be enjoying the low-cost, highly effective national health insurance that has been available for decades to the citizens of Canada, Japan, the European Union and virtually every other advanced nation on Earth.
Indeed, if that system were in place now, no greedy doctor would be able to turn his back on the needy. The biblical admonition "physician heal thyself" seems apropos.
Madsen is a contributing writer to www.onlinejournal.com.
Editor's Choice Videos
Join the Discussion
The Modesto Bee is pleased to provide this opportunity to share information, experiences and observations about what's in the news. Some of the comments may be reprinted elsewhere on the site or in the newspaper. We encourage lively, open debate on the issues of the day, and ask that you refrain from profanity, hate speech, personal comments and remarks that are off point. Thank you for taking the time to offer your thoughts.