(+20 rating, 4 votes)

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Good news! Humana and Wellpoint are raking it in from Medicare! That just makes me incredibly happy for them!

Hmm…. Something seems askew, doesn’t it? Here is my reality of Medicare:

1. The only reason I accept Medicare is out of a sense of duty. I feel that we can’t ignore the elderly. The fact is, Medicare reimbursement rates are too low for a primary care physician to survive on. I have been able to get by so far only via increased efficiency leading to higher volume (and I see other insurers to offset Medicare).
2. Medicare’s “low overhead” is a false overhead. The government infrastructure needed to support medicare is not taken into consideration in the same way that insurance company costs are considered. Those who say “Medicare for All” is a solution because of its low overhead, don’t take this into consideration. Come on, do you really expect the government to be more efficient at anything?
3. Medicare rules prohibit “up front pricing.” I cannot openly state any prices that are not in line with what I am charging medicare, nor can I give a discount to a patient without insurance. If I give a discount, I am accused of “defrauding Medicare.”
4. If I opt out of Medicare, I must do so for 2 years.
5. I cannot have a mixed Medicare/Concierge medical practice. I cannot charge anybody anything above and beyond Medicare’s reimbursement. Even if I want to offer extra services that are far above and beyond, I cannot pass the cost on to any Medicare patients. If I want to do a practice with innovative solutions for payment, I have to get rid of Medicare.
6. The “welcome to Medicare” preventive care package is a joke. The details are so complicated that it is nearly impossible to be sure you are complying.
7. The Medicare “pay for performance” initiative (PQRI) is even worse.
8. If “Medicare for all” were made law, I would quit medicine and become a talk-show host (or work at a fairgrounds somewhere). Seriously, the exodus from medicine would be unprecedented.
9. 99% of physicians have not coded every chart exactly right for medicare and so are at risk of being audited and nailed for Medicare fraud. Bad Doctors!
10. If you rearrange the letters of “Medicare” you get “Dime Care,” which pretty much approximates the average reimbursement.

On the bright side, this is an election year coming up. Now the politicians are going to totally solve this problem for us. Thank goodness for that!