Editor’s note: This is the second in a series of columns, for which Farmer interviewed five talented physicians. So they could speak frankly, and they did, Farmer agreed not to quote them by name.
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Medicare occupies such a huge chunk of America’s health care environment that when the program is ill, most of us feel the pain or care about someone who does.
Maybe the only thing about Medicare on which everybody can agree is that it cannot continue in its present form. The doctors I interviewed aren’t thrilled with private insurance providers either.
• “In 1965, when Medicare was created, people generally lived into their 60s, not routinely into their 90s, so most got Medicare for just a few years. There were four workers for every one recipient.
“Also there were no stents, no heart bypass surgery, no artificial knees or hips, no defibrillators. It was not a terribly expensive program because there were not that many people to take care of and a lot of people were funding it.
“Now the baby boomers are turning 65 so we’ve got this burgeoning population. They want to live longer. They are going to live longer. They want to have healthier lives. We have all this technology and technology is expensive and the country clearly cannot afford it.
“We have people who say, ‘Hey, it’s free, so why not go to the doctor? And while I’m at it, I’d like a stress test.’ It happens every day around the nation.”
• “Many doctors are opting for concierge-type practice, meaning they’ll see you for a fee but they will not accept Medicare, because of its complexity and low level of reimbursement.
“Those who can make a choice are trying to opt out of seeing Medicare patients and people that are still in the system are being required to see more patients to keep income levels up.”
• “Seventy percent of what I do is Medicare patients, so I’m told what I can get paid. I can’t charge any more or any less. I can’t offer anybody free service. So we have that business model of a fixed income with rising costs. We still have to pay insurance for employees and it costs more money to do business and when you have a fixed income, it’s a bad model for us.
“Medicare is tough because it’s not the most reliable payer. We’ve been on a freeze for a while. Sometimes they don’t even pay. They’ll say it’s on hold. Any other business where you don’t get paid you stop doing business with them. People don’t go into a restaurant and order and then say, ‘Maybe we’ll pay you next month.’
“I am fearful for the patients of where Medicare is going. Most people here have a supplemental or secondary insurance. They’re blessed and I don’t know if they know they are blessed. We have to bill Medicare first and we have to do what Medicare tells us.”
The five doctors I interviewed are often critical of insurance companies as well.
• “Suppose I have to call them and say a 50-year-old man needs a stress test. I had that conversation this week. The insurance company person asked, ‘Is there a family history?’ (No.) ‘Is he having shortness of breath?’ (No.) ‘Is he a smoker?’ (No.) ‘Well, then he’s not getting a stress test,’ meaning insurance won’t pay for it.
“Another insurance company may have different questions. One thing Medicare is good for is that I know exactly what they want.”
• “I’ve been on a telephone peer-to-peer review where (the insurance company) denied something I really thought a patient needed. And I have told the doctor on the other end, ‘I need to know your name so that I can put it in the chart. That way when this patient has a heart attack it’ll show you were the one that declined.’ He hung up on me.”
• “All the insurance companies do is to suck money out of the system.”
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In future columns I’ll share the thoughts of these doctors on Obamacare, the quality of people entering the medical profession and what the doctors believe patients should do to ease medical concerns, for themselves and for the nation’s health care system.
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Don Farmer is a former ABC News correspondent and bureau chief and CNN news anchor. He can be reached at email@example.com.