Back in 1985, when I was just starting off as a doctor, Anna, a 60-year-old woman with diabetes, was assigned to my new medical clinic at the hospital. Something about her easy polite manner appealed to me and we instantly became friends.
She began to come to see me at regular intervals, and she was one of the few patients I offered the chance to follow me to my private practice when I left the clinic. Her daughter and granddaughter brought her happily to each visit. Over the years I treated her for insufficient blood flow in her legs, heart failure, a small stroke, a brief episode of anxiety, and of course the diabetes.
As her medication list grew, and she required more and more treatments and tests and careful thinking to keep her healthy, I remained committed to her care, and our mutual attachment grew.
I did not pay attention to how much time it took to keep her well or how many prescriptions I had to write, even as the number grew. I have long gotten used to the fact that Medicare pays me less than private insurance does, and that I write more prescriptions and order more tests for elderly patients with more medical problems. I rely on a network of similar-minded specialists who participate in Medicare and aren’t business-minded, and we all agree that we are only able to work with Medicare because we can order the tests and treatments we feel are necessary.
Now, 86-years-old and still in good health, Anna herself has been the beneficiary of the art of medicine that Medicare has allowed me (as well as her cardiologist, diabetes specialist, and vascular surgeon) to practice. From saving her infected leg, to dealing with a sudden bout of heart failure and worsening anemia to adjusting her insulin, it has been the freedom of doctors to practice unfettered medicine that has been at the heart of her remaining well.
But even with the freedom that Medicare offers, it is still difficult to work with, and doctors everywhere are concerned that the Medicare reality will be changing rapidly for the worse as ObamaCare fully kicks in in 2014.
ObamaCare includes $415 billion in cuts to doctors and hospitals. Medicare’s new Independent Payment Advisory Board will make recommendations to implement these cuts that could affect both Anna’s treatment options as well as my reimbursements. Doctors are nervous about how these restrictions under ObamaCare will interfere with their Medicare practices.
Both a 2010 American Medical Association (AMA) survey and the 2011 National Ambulatory Medical Care Survey found that about 17 percent of physicians were already restricting the number of Medicare patients they treat even before ObamaCare.
Imagine what will happen as the new cuts take place: hospitals will struggle and doctors will quit Medicare.
Consider this: Studies from Drs. Wu and Chen at Tulane have shown that large Medicare cuts to hospitals result in increasing death rates among patients. A 2011 survey by the Texas Medical Association revealed that a full half of Texas doctors are planning on dropping Medicare.
A recent survey from the Doctors Patients Medical Association found that 74 percent of doctors say that they will stop accepting Medicare patients due to the restrictions of ObamaCare. It is not clear that restricting Medicare choices by cutting doctor and hospital reimbursements for procedures that are deemed unnecessary by the new Medicare board will save money if it leads to doctors dropping out and patients becoming sicker if they end up with less access to timely care.
Medicare Advantage is a popular program among seniors that already allows them to turn traditional Medicare into private insurance by contracting with an insurer. But ObamaCare cuts federal funding to this program by $216 billion, which will also lead to more restrictions and make it less workable for both doctors and patients.
Introducing more choice instead, as the Romney-Ryan plan does, by allowing Medicare patients to use their allotted money to buy private health insurance, is an idea that makes sense and is more in keeping with what’s best about our health care system. More choice means more competition, where doctors and patients are able to choose among plans they can work with the best. Allowing wealthy seniors to buy more expensive plans while subsidizing poor seniors who can’t afford a basic plan is an idea proposed by Ryan that also makes sense and could save the system money.
Without more privatization of Medicare, I am worried that the time will be coming soon when I simply won’t be able to afford to take care of my friend Anna or patients like her. Office expenses have risen over 30 percent in the past decade, while reimbursements to primary care doctors like me have remained flat. With looming cuts and restrictions, our elderly patients’ future is in jeopardy.
Marc Siegel, MD is an associate professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He is author of The Inner Pulse and a member of the Fox News Medical A Team.