Food for thought as the forces for and against health care reform, and the different models for reforming the health care system begin to align.
Most recent proposals, including President-elect Obama's plan, advocate augmenting the current system of private health insurers and the government-run Medicare and Medicaid.Myths abound, and part of the process of forging a workable solution to the American health care morass will be to move lawmakers and the public towards reality.
Medicare, which provides payment for the majority of the medical care for Americans over the age of 65, is often pointed to by policy-makers as a model of health care efficiency. Reportedly, only 3% of Medicare expenditures go towards administrative costs, compared to 20%-30% for private insurers.However, while direct expenditures on Medicare administrative costs may be low, layers of draconian regulations that Medicare has created, and indirectly passes on to the rest of the health care industry, create incredible amounts of waste.
Case in point...I love taking care of the elderly. In the past, my practice has gravitated towards geriatrics, and while I love taking care of patients of all ages, I think I enjoy my older patients the most. My practice moved about 40 miles this year, from Maryland to Virginia. I have been enrolled with Medicare for almost 10 years. When my practice switched states, I had to enroll with another Medicare provider. I filled out stacks of papers. The only change was the address. Five months later, I am still not enrolled. In the past, to make up for such delays, Medicare allowed retroactive billing, so that physicians could see Medicare patients, and when their enrollment became official, they could receive payment for the work they had done. Bad for cash flow, but if you could get by that, at least you could see patients. Now, Medicare has proposed limiting retroactive billing to only 30 days. Squeezed on all sides, it's damned hard to see Medicare patients.
Need more convincing? Medicare establishes the payment schedule for the care that doctors provide, and private insurances tend to use these rates to set their own (did someone say price controls?). Unfortunately, Medicare reimburses the work of primary care physicians at a far lower rate than other types of physicians. Many physicians have found that it costs them more to see a Medicare patient (business overhead) than they are paid. At least two things have happened as a result. First, many primary care physicians are unable to see Medicare patients (the people who often need the most help). Second, medical students, many of whom incur incredible amounts of debt during medical school (many of my Georgetown medical students report debt levels between $200,000 and $300,000!!), avoid going into primary care medical specialties. A recent JAMA report showed that only 2% of American medical students are going into primary care, though it is well known that primary care doctors are the backbone, and the most cost-efficient part of the health care system.
In other words, Medicare has systematically created a crippling shortage of primary care physicians.
What is the lesson here? Is a government entity by nature unable to administer health care in America? That conclusion ignores that Medicare has many positive aspects. As mentioned earlier, it is a far more efficient administrator than private insurance.Case in point...I love taking care of the elderly. In the past, my practice has gravitated towards geriatrics, and while I love taking care of patients of all ages, I think I enjoy my older patients the most. My practice moved about 40 miles this year, from Maryland to Virginia. I have been enrolled with Medicare for almost 10 years. When my practice switched states, I had to enroll with another Medicare provider. I filled out stacks of papers. The only change was the address. Five months later, I am still not enrolled. In the past, to make up for such delays, Medicare allowed retroactive billing, so that physicians could see Medicare patients, and when their enrollment became official, they could receive payment for the work they had done. Bad for cash flow, but if you could get by that, at least you could see patients. Now, Medicare has proposed limiting retroactive billing to only 30 days. Squeezed on all sides, it's damned hard to see Medicare patients.
Need more convincing? Medicare establishes the payment schedule for the care that doctors provide, and private insurances tend to use these rates to set their own (did someone say price controls?). Unfortunately, Medicare reimburses the work of primary care physicians at a far lower rate than other types of physicians. Many physicians have found that it costs them more to see a Medicare patient (business overhead) than they are paid. At least two things have happened as a result. First, many primary care physicians are unable to see Medicare patients (the people who often need the most help). Second, medical students, many of whom incur incredible amounts of debt during medical school (many of my Georgetown medical students report debt levels between $200,000 and $300,000!!), avoid going into primary care medical specialties. A recent JAMA report showed that only 2% of American medical students are going into primary care, though it is well known that primary care doctors are the backbone, and the most cost-efficient part of the health care system.
In other words, Medicare has systematically created a crippling shortage of primary care physicians.
The lesson is that we need to be able to identify those aspects of our system that work, and those that do not, to keep what does, and throw out that which does not. We need to retool without fear to find what will work and what will cost less...and our guiding principle should be...KEEP IT SIMPLE.
BE HEALTHY
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