Not all practicing doctors will readily admit this, but we all look at Medicare (and all health insurance for that matter, public or private), the same way. Medicare is cumbersome, an unnecessary interface between us and our patients, and most importantly, it doesn’t pay us sufficiently to justify the work we do, the growing technology we must master, and the series of complex health problems (because of the great treatments we offer) that go along with keeping patients alive much longer.
In other words, it is harder to be a doctor taking care of elderly patients than ever, and doctors are being paid less and less to do so. We continue to be penalized whenever the services we provide outstrip the economic growth rate, and we are currently facing a 27% percent across-the-board Medicare cut on January 1st. Each time that cut is delayed (the House is proposing delaying it two years, the Senate 2 months, and it is likely that the Senate version will prevail), the number increases.
But consider that as a practicing physician it is hard to resist ordering expensive tests for Medicare patients because first, patients want the best care possible and second, I am liable if I miss something and Medicare isn’t. Finally, let's be honest, it's much easier to say that a test wasn’t necessary after the result comes back negative.
The government can’t continue to penalize doctors and expect the same care. A survey by the AMA last year determined that close to 20% of practicing physicians were already restricting our practices to Medicare patients before any massive cuts to our fees. Imagine what will happen to seniors’ access to health care if the looming 27% cut in fees are allowed to go through.
Clearly, something has to be done to cut Medicare, though I don’t happen to believe that physician fees are the place to start. This out of control train will be costing federal taxpayers close to $1 trillion dollars by 2020. Seniors are much healthier and live much longer than they used to, so the idea of raising the retirement age to 68 makes great sense and would save billions.
Another way to cut bloat out of the beast would be to introduce stiff co-pays or deductibles for non-essential services to discourage overuse.]
Finally, Congressman Paul Ryan (R-Wisc.), and Senator Ron Wyden (D-Ore.) have gotten together on a proposal to partly privatize Medicare by providing payments to seniors to purchase insurance at rates consistent with current premiums while maintaining the traditional option.
I think this plan makes sense because very old or sick patients may not have the ability to choose the right plan and would be better off with traditional Medicare while for others private insurance will be better. Since insurance companies can only make profits by being efficient while the government is famous for cumbersome money-pit bureaucracies, this plan may very well save the government money.
But before I would support the Ryan-Wyden proposal, I would need to see at least one provision removed. There is a section which calls for a reduction of fees whenever the cost of health services exceed the economic growth by 1 %. It is precisely this kind of thinking that is behind the 27% Medicare cuts that we doctors are currently facing. Again, doctors should not be directly penalized for out-of-control health care costs or patient care will suffer. We are already cut to close to the bone.
The fact that the White House is already ridiculing the Ryan-Wyden proposal is yet another example of the president’s rigid uncompromising approach to health care. ObamaCare gives us a lot more insurance, many more Kafkaesque committees and Rube Goldberg mandates without any real improvement in health care or reduction in costs.
Marc Siegel, M.D. is an associate professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He is a Fox News Medical Contributor and author of several books. His latest book is "The Inner Pulse; Unlocking the Secret Code of Sickness and Health."