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It Begins: Medicare Patients See Long Waits for Doctors

John on November 26, 2010 at 10:35 am

From the right-wing extremists at the Washington Post:

Want an appointment with kidney specialist Adam Weinstein of Easton, Md.? If you’re a senior covered by Medicare, the wait is eight weeks.

How about a checkup from geriatric specialist Michael Trahos? Expect to see him every six months: The Alexandria-based doctor has been limiting most of his Medicare patients to twice yearly rather than the quarterly checkups he considers ideal for the elderly. Still, at least he’ll see you. Top-ranked primary care doctor Linda Yau is one of three physicians with the District’s Foxhall Internists group who recently announced they will no longer be accepting Medicare patients.

“It’s not easy. But you realize you either do this or you don’t stay in business,” she said.

Recall that these steep cuts to Medicare reimbursement rates are the way in which the Obama administration was able to claim that a) Obamacare cost less than a trillion dollars and b) it would bend the cost curve. In fact, the administration now has a stark choice between instituting the “doc fix” which would rescind the Medicare cuts or welcoming in the era of decreased access and rationing via long wait times. They don’t have long. The rate cuts to Medicare reimbursement are set to begin December 1st.

But the article actually gets even deeper into the foliage of unintended consequences. It turns out that failure of Medicare to keep up with private reimbursement rates has led doctors to charge for more tests and services:

statistics also suggest many doctors have more than made up for the erosion in the value of their Medicare fees by dramatically increasing the volume of services they provide – performing not just a greater number of tests and procedures, but also more complex versions that allow them to charge Medicare more money.

From 2000 to 2008, the volume of services per Medicare patient rose 42 percent. Some of this was because of the increasing availability of sophisticated treatments that undoubtedly save lives. Some was because of doctors practicing “defensive medicine” – ordering every conceivable test to shield themselves from malpractice lawsuits down the line…

Whatever the cause, the explosion in the volume of services provided helps explain why Medicare’s total payments to doctors per patient rose 51 percent from 2000 to 2008.

Whatever we save on individual procedures, we lose in volume! This is why Dr. Berwick is constantly talking about changing the “fee for service” model. He knows that the government’s attempt to cut doctor reimbursements is a failure because doctors simply order more tests to make up the difference. So what’s the solution? Change the entire payment model to prevent this.

Dr. Berwick has famously said that he doesn’t believe the market can solve this problem. What he fails to say is that government interference is largely responsible for causing the problem he wants to fix. There’s only one way to solve this problem and that’s to make Medicare the only game in town. That’s the long term solution envisioned by socialists like Dr. Berwick. Once there are no private options left, doctors will take what the government gives them.

Finally, it’s worth noting that the administration saw rationing on the horizon long before the bill was passed. They welcomed it:

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