medicare - again

Yesterday the Senate passed legislation to prevent a decrease in medicare payments of 10.6% for physicians. A 10.6% decrease in PAYMENTS for my practice (overhead of 60% - which is fairly typical) would translate to a 75% loss in income.

The fight was between primarily Republicans backing the private insurance companies that handle medicare contracts (Medicare Advantage) and doctors (AMA). This time, AARP joined with the AMA because they were concerned about the possibility of decreased physician access.

I know two Internists who were going to stop taking new medicare patients (and still may) -- IN THIS TOWN! Others are considering retirement. Some are considering moving. I know many physicians who work in non-medicare saturated "markets" who already refuse to take medicare. The Mayo Clinic in Jacksonville doesn't take medicare.

Senator Kennedy showed up to vote for the doctors with a brain tumor. Nine republicans (including our not so illustrious Martinez) changed their votes due to too much voter pressure. Bush has vowed to veto this bill to protect his Insurance company friends. (Senator Frish as everyone remembers never had any conflict of interest despite the fact that his family owns Columbia health care).

Things are really getting out of hand. There is a major health insurance crisis here. Right now, the doctors are suffering. I know Internists working 80 hours per week making $125,000. That's a lot of money. Still, it's $62,000/job (they're working two full jobs). A medicare follow up visit charge of moderate complexity is $80 while cleaning the dryer vent is $90. Pretty soon medicare patients are going to start to suffer. A 25% pay cut to these friends of mine would have meant that they were supposed to be paid $46,000 for a full time (40 hours/week) job. I suspect doctors would be leaving in droves under those circumstances. They would have to if they have families.

In January 2010, doctors are now "scheduled" for a 20% cut in pay, and this fight is going to played out all over again. We have had no raises and several "small" cuts (one was 5%) over the past decade while costs just keep going up. People are either retiring, leaving medicare, or looking for other work.

It's time for people to start fighting against the insurance companies. We should have seen this when they refused to pay for the damage that was done during hurricane Katrina.