THE VIRGINIAN-PILOT
Copyright (c) 1994, Landmark Communications, Inc.
DATE: Sunday, August 21, 1994 TAG: 9408190819
SECTION: COMMENTARY PAGE: J1 EDITION: FINAL
SOURCE: BY KEITH MONROE, STAFF WRITER
LENGTH: Medium: 87 lines
My father is 84. In May he moved to Virginia Beach to share a home with me and his daughter-in-law and his granddaughter. He found food stores and restaurants to his taste, a bridge game, a barber, an auto mechanic and other necessities of life. But he had a very hard time finding a physician.
One practice after another said they'd be happy to have his business, until they learned his age. Then one practice after another said they weren't taking any more Medicare patients.
Frustrated by this situation, I began working my way up the health care food chain. I called back one of the practices that had refused to see my father to try to get an explanation. Instead, I got put on hold, hung up on, put on hold a second time and compelled to listen to canned calypso music. Finally, I was referred to Tidewater Health Care - the medical conglomerate that is the practice's parent.
After being shunted from one office to another I finally wound up speaking with Vice President Vicky Gray who explained some of the facts of life - and of Medicare politics.
She admits that the unavailability of health care for older Americans - prime consumers of it - is a growing problem. In fact, she cites a study concerning Virginia Beach that suggests 1,200 new Medicare patients a year enter the market - either by turning sixty-five or by moving to the area. Of those, 300 - or 25 percent - have great difficulty getting a primary care physician to accept them as patients.
Why? Gray says it's because the government has tightened the screws. ``Medicare reimbursement is poor compared to other payers,'' she says.
Gray cites a national study that suggests that if a physician confined his practice to Medicare patients, at present reimbursement levels his annual take-home pay would average only $7,000 to $21,000 after expenses.
Defenders of the government's tightening of Medicare reimbursements claim they are squeezing out waste and extravagance, slowing the double-digit annual increases in health care costs, and providing a welcome attempt to spend the taxpayers' money more prudently.
Some reformers want to give the rest of the medical landscape a dose of the same medicine. That debate will play itself out, but in the meantime a two-tier system has been created in which doctors are rewarded more handsomely for treating the privately insured than they are for dealing with Medicare patients.
So each year, 300 Virginia Beach residents and thousands of Medicare patients nationwide find themselves in a peculiar Catch-22. They are entitled to government-funded health care, but they have increasing difficulty getting health care providers to provide it.
My complaining did succeed in eliciting a list of physicians who are willing to accept new Medicare patients. Gray says Tidewater has deliberately set out to address this problem by creating an affiliation of practices so that doctors - like insurance companies before them - can create a larger pool of patients and thus dilute the risk of treating those who are relatively unremunerative, like Medicare patients.
My father has now succeeded in getting a practice to accept him. But patients shouldn't have to work their way slowly through the phone book seeking a doctor willing to see them.
Those who oppose health care reform will point to this small horror story as evidence of what happens when the government starts meddling with health care. But it's far too late for the government to stop. Millions of Americans now rely on government-mediated health care, and agrowing percentage of all health care dollars are being spent by a single payer - Uncle Sam.
Instead, this example is evidence that reform can't be avoided. I wouldn't claim to know how to sort out all the competing claims of physicians and hospitals, bureaucrats and insurers. But it is obvious that it's often the patients who get lost in the shuffle.
Reform must take care that good intentions don't wind up having unintended consequences. Certainly any fixes must take market forces into account. Doctors may be compassionate healers, but most are also self-interested small-business men. And if the choice is between business that is only marginally profitable (Medicare patients) and business that pays a high rate of return (the privately insured), doctors will inevitably tend to shun the former and pursue the latter.
But doctors and other health care behemoths have little problem defending their interests. They have lawyers and lobbyists and professional organizations to speak for them. Money talks, too. And they can adapt to a changing environment, as their de-emphasis of Medicare patients demonstrates.
It's the well-being of patients that needs to be protected. After a lifetime of work and contribution, patients shouldn't find themselves persona non grata when they try to collect on a promise made by the government. They shouldn't have a hard time acquiring health care just when they need it most. by CNB