What’s Fair? The Medicare Crisis
Medicare cuts are in the news again. Medicare payments are slated to be decreased in January, and the anxiety is already mounting. According to KUT news (a part of the npr digital network), one-half of doctors in Texas have said they will stop taking Medicare if the cuts are enacted.
Though this is alarming news, it is not necessarily surprising. Doctors have been quietly ceasing to accept Medicare for some time now, in large part due to the threat of cuts to the nationwide program for people over sixty-five.
Medicare rates have already been reduced, though it is unclear how much so per specialty. In my own field, Medicare reimbursement rates have dropped almost 20% since I entered the field in the 1990’s.
Though the cuts that have already taken place ruffle the feathers of some medical clinicians, what seems to worry doctors more are the threat of annual and ominous SGR (sustainable growth rate) cuts which threaten to take a good chunk of change from the pockets of doctors. We have been able to stave off SGR cuts since the early 2000’s, but it is not clear that this year will be one in which doctors emerge unscathed. Currently, some physicians face an almost 30% reduction in pay if the government does not do what it has previously done, stall changes in Medicare reimbursement.
As we all know, Boomers are aging and understandably expect what was promised to them—healthcare when they turn sixty-five. I am not naïve to the realities of our national debt and the costs of health care. But reducing the reimbursement rates of physicians and psychologists has a number of serious consequences. Simply put, we need people who accept Medicare. Even now, I have trouble finding physicians or psychologists who accept this insurance when I am trying to refer someone. And the irony is, Medicare is not that hard to deal with. They are much less oppressive than other insurance organizations that require endless paperwork for treatment.
But the fears of SGR cuts, which have been going on for almost a decade now, have made clinicians fearful. Why become a Medicare provider if all you do is worry about a major cut to your livelihood?
Let me be clear, I do not think that physicians who are anxious about the impending SGR cuts are greedy. In fact, I believe the opposite. Student loans for physicians average in the 150,000.00 range. People in psychology doctorate programs also have significant debt. And since primary care physicians and psychologists are already receiving relatively low reimbursements compared to other specialties, the idea of cuts to salary might just be too daunting for those who do want to accept Medicare.
Then again, I know some physicians and mental health clinicians with trust funds who don’t care how much they make. These doctors still take Medicare and will likely continue to do so. But for the majority of clinicians without family money and young children to raise, or even those who want a nice apartment in an urban area, they need to make a little bit of money as a reward for the ten-plus years they spent in school, not to mention all of the lost time in earned income that could have gone to a retirement account. Not all clinicians can afford to be generous. Many wish they could be.
Doctor’s work hard to get to where they are. They should be compensated reasonably. Isn’t it better for all of us if doctors feel that they are paid well for their time?
I have a friend who paid a medical doctor privately for specialty services until she was sixty-five and qualified for Medicare. She told me her doctor, who had always been so nice to her, cut short her visits by half the time once she started using her Medicare to pay. It is just not fair to doctors or patients when money becomes the primary emotional currency that determines our interactions in medical encounters.
We need doctors and they need us. It is not unreasonable that they are paid for their time and expertise. In our national budget, we may be able to cut a lot of things. Is it really fair or reasonable to cut the services of people who have spent a decade of their life to become doctors or psychologists? I hope the intellectual pursuits of those who want to help people still matter.
Greenberg, T. (2011). What’s Fair? The Medicare Crisis. Psych Central. Retrieved on October 19, 2017, from https://blogs.psychcentral.com/aging/2011/10/who-determines-what%e2%80%99s-fair-the-medicare-crisis/