Going to the Doctor

By Karen Sternheimer

My father now jokes that his time is structured only by his doctor’s appointments. He is exaggerating a bit, as fortunately he is relatively healthy and active. Because he has been self-employed for more than three decades, he always had to buy his own health insurance until he qualified for Medicare just a couple of years ago. As he got older, his premiums grew so large—despite no major health problems—that he would buy a policy with a very high deductible, which is only useful for catastrophic illness.

So while reaching that 65-year milestone might have been difficult for some people, he was relieved to finally have affordable health care. I notice he is much better about getting regular check-ups and is far less concerned about costs. Out of habit he still asks how much procedures will cost and I have to remind him that he need not concern himself with those things anymore. It’s very likely that he is healthier now than a few years back now that he does not hesitate to visit the doctor.

Just a few weeks ago, he found out that one of his long-time physicians was retiring. As is common in this scenario, the doctor gave him a list of others in his specialty that he could switch to. Some of the doctors he called were closed to new patients. More troubling, several on the list told him that they do not accept Medicare.

Unfortunately, this is not a new problem. USA Today ran a story on this issue back in 2001, and A News Hour with Jim Lehrer featured the problem in 2002. But it is new to those just beginning to rely on Medicare, and there will be many more people facing this issue as the "Baby Boom" generation retires in larger numbers each year. The reluctance of some doctors to accept Medicare comes at a time when health care costs are rising. The New York Times recently covered this issue, citing that average insurance premiums have doubled since 1999, and approximately 57 million people live in families where health care costs cause significant financial strain. Couple this increase with the massive layoffs Americans are facing, and we are left with a potential health care catastrophe.

I am fortunate to have good (although not cheap) health insurance coverage with my employer. But even people with insurance are not immune to high costs of health care. One of my doctors announced last year that they would no longer be an “in network” provider. They would still accept health insurance and bill my carrier as a “courtesy” to me, but I would have to pay the full cost of the visit up front and they would reimburse me whatever my insurance company paid them. I had to wait months (and make a few phone calls) to get my money back, and no longer had the benefit of a pre-negotiated rate for my office visit. A major benefit of health insurance is that the doctors in their network agree to accept the rates the insurance company determines to be fair and reasonable. Instead, I had to pay about four times as much for my check-up as I did the year before.

We should also consider the doctor’s perspective here. My doctor’s office had previously been overflowing with patients, and I knew whenever I had an appointment I could be in for a long wait. She was always apologetic about being late, and she seemed pretty stressed out from rushing from patient to patient. After the change, she was much more relaxed and the waiting room was all but empty. It’s likely she has fewer patients but earns the same if not more with less stress.

Because insurance rates sometimes don’t covering their basic operating costs, doctors struggle financially too. Medicare is notorious for offering little reimbursement for doctors, and doctors know to expect long delays before they receive any payment at all. Factor in the cost of paying staff to fill out massive amounts of paperwork and follow up on submitted invoices, and those costs can make it difficult for some doctors to make ends meet.

Some doctors have decided not to accept health insurance at all, some charging what amounts to an annual membership fee to be part of the doctor’s practice In some cases these doctors provide additional services, including the old-fashioned house call. What might seem like the return of a quaint tradition is typically only available to those with the disposable income to afford the fees.

It is no secret we are facing a crossroads in health care. President Obama has promised to address this problem during his term, and it will be no small feat to figure out a solution. When Medicare was signed into law by Lyndon Johnson in 1965, the average life expectancy was under 70; in 2005 (the most recent year for which we have data) the age had risen to 77.8. Women’s average life expectancy is now 80. While these numbers might not seem dramatic, consider that Medicare is now covering recipients an average of nearly eight more years, and that most costs are incurred in a person’s last few years of life.

Our medical technology is dramatically different from 1965 as well; with more tests and treatment options come more costs. As our population continues to age and face health challenges, the Medicare program will likely face more difficulties. With medical advances, diseases that might have been untreatable in the past can now be treated as chronic conditions. But this ability to prolong life comes with a cost, and we need to figure out how to address that cost. If doctors can no longer afford to accept Medicare, who will care for our parents and grandparents?

Comments

[jbird]

This is just another example of how our government cares more about making fat pockets for the few and screwing the rest of us over. Medicare is no different than social security in this aspect and this also goes inline with my other post about how people care about what is important to them at a certain stage in their life. Two years ago Social Security was talked about every day on the news, now you hear Medicare. This is what happens when a system does not change with the times. Nothing else is stagnant, CEO's and congress men/women have no problem raising their salaries, but when it comes to a program for the masses the government has dropped the ball. The problem has become so bad that no one wants to fix it. Obama will do the same thing Bush did. He will "reform" Medicare, but in reality all he will do is put a band aid on the problem. In a way this is a type of solidarity between classes. The people who can afford to fix this problem and who have the means to do so will not. Those people will just go to doctors and pay cash, knowing they have the best care money can buy. Insurance companies have taken advantage of people for so long they have reached a Master Status. People will pay because the want to have a healthy family, yet every year the rates go up for no real reason. I work at a pharmacy for example. I have people come in to my work one month and pay 5 dollars for a prescription. Then their coverage resets and the same medicine costs the same person 40 dollars. The cost of the drug did not go up eight times why did the co pay? That’s an example of someone who does not have a deductable. Some people have to pay 3000 dollars before their insurance will even start to pay for their meds. Healthcare in America has been ruined by greedy people who care just about the money and no longer their patients.

[Alissa Beer]

This article just says how messed up our healthcare is in America. It isnt messed up like it is in Mexico, and places that where have crappy or NO medical care at all, but ours is messed up because of the costs it takes to just stay alive and healthy. The father of the author of this article is a perfect example of most Americans (like my own boyfriend) who avoid the doctor due to the costs. I personally think that is ridiculous. The price to stay healthy is beyond ridiculous and many people dont take care of themselves because of it and that is sad. I'm not saying that people should go to the doc's for free or for EVERY little thing, but insurance should still be accepted! Yeah sure, SOME doctors get THEIR wages cut to "ends meet," but what about the people that dont even make ends meet? And in my opinion, doctors should become doctors to HELP people, not just to make a huge wad of cash. People are just so selfish in that field and forget that people are still people and they arent just patients so the doctors can make money- they are there for help.

[Lei He]

My parents have medicare. Almost all big hospitals around here accept medicare. So they can get good medical services. It’s impossible that no doctor or hospital accept medicare. If that happens, it’s time for the government to make big changes in medical systems. I wish health insurance is the right not the privilege for all of the people in US.

[pediatric ENT]

It's the new nature of medical technology, more tests and treatment options come more costs. We must be wise on selecting insurance.

Luke Hamilton

[Morgan Humble]

Despite all those levies, your father is assured of a secure future. It was a good move on his part. I hope his decision may also influence people's opinions on health plans.