i just imagine that many of our proffesional doctors running a blog like yours and delivered to us an important information/issue like this articles.

tx.

In my area, Medicare pays $0.35 on the dollar to the hospital in reimbursement–not to the docs, be they generalists, specialists or hospitalists. My hospital, where I work, serves the inner city poor, and it considers $0.35 on the dollar GOOD reimbursement, because . . .

Medicaid pays only $0.13-$0.14 cents on the dollar. And as you know, many poor and elderly are dual-eligible.

My own PCP doesn’t accept Medicare patients, though he will keep patients who have been seeing him for years before they got into the Medicare age range.

Knowing just this little bit, just this partial picture, put forth by these bloggers and responders, it seems to me we have to look critically at the health care reform proposals of the presidential candidates, and decide if their plans address these issues sufficiently well.

We are so very distracted by the Iraq war that we may fail to attend to the domestic policy proposals of the presidential candidates. As Dr. Rob says elsewhere in his blog, TO OUR OWN PERIL.

The boomers are going to HIT the healthcare system with blunt force in the next few years, and this issue will cripple them/the economy. It is critically important, financially and ethically, that we come up with some kind of fair healthcare for all program.

Those of you who blog, read and reply and who feel you can deal with the complexeties of this issue really should put yourselves out there. Contact candidates. Contact the media. Contact your professional organizations. You are all so smart—and I am not speaking in the usual humorous or ironic vein now—you need to say your piece to the people and organizaions which have clout. Please, do this.
Chris and Vic

Can you imagine working at a job and having your employer tell you that they are planning on cutting your wage 40% in the next 5 years. Your gas bills continue to rise, your health insurance conintues to rise, your food bills conintue to rise, but your employer says, too bad, this is our rules. That is the state of medicare. It is no wonder less than 20% of medical students are entering primary care, a field, all ready being decimated, with margins so tight primary care docs acutally lose money every time they see you. We have a socialized reimbursment system with a capitalistic cost structure. The fixed top line is crossing the ever rising bottom line. In the business world, that spells bankrupcy.

Specialists have a very large buffer before they drop out of medicare because they are reimbursed at a much larger rate, compared with the time involved and compared with primary care time. They have the ability to do more procedures to counteract the decreased reimbursements. This is exactly what the trend has been over the last few years.

In my community, new access is becoming an issue. Imagine when those cuts finally go through, there will be a mass exodus of primary care docs from medicare, as they have already done with medicaid. Your insurance will be worthless. No one will accept it. We are trying to make lemonade without the lemons. There needs to be more money for primary care to survive. It is not greed. It is reality. Some primary care docs make less than highschool grads in unionized jobs who’s years of educational training is far inferior to the time required to become a board certified MD. The economics of the situation, by human nature, is killing the field of primary care. And money talks. And you know what walks.

The result has been hurried offices, double booking in an effort to stay “revenue neutral”. Procedural physicians can increase the number of expensive procedures to stay ” revenue neutral” as the value of all services continue to be cut. A primary care doc can only double book to a point., What’s left is a system where primary care docs, who are cognitive by nature, are not payed to cognate (they don’t have time), but rather to see the most patients in the least amount of time. You would be surprised how much a primary care doc could take care of in their clinic if they were paid enough to see you longer. Instead, referal to specialists lead the way, as there are 3-4 others in the waiting room. And by nature, specialists do procedures (which pay more), The cycle continues.

To break the cycle and save primary care, one needs to break the cycle of substandard reimbursment, when compared to specialists. Only then will medical students return and weill established practices survive and thrive and fully function in their cost saving abilities.

To break the cycle, you either need to increase funding (government), or pass on more costs to the patient. I have blogged about some of my ideas at my site.

http://thehappyhospitalist.blogspot.com/

You do have the option of opting out of Part B and could do as you suggest and apply your funds to your primary and specialist physicians. However lets say you are are admitted to the hospital for a bypass. Do you think the cardio/thorasic surgeon is going to accept the savings in premiums as payment in full? What about the horendous costs that chemotherepy can ring up? Without debating the merits of reimbursement problems to providers that is what insurance is for. Medicare and supplements are forms of insurance.

Even if your house is paid off, would you go without homeowner’s insurance and self-insure against fire? Of course not because you’re not willing to accept the financial risk but you can. Same with your health care.

That “healthcare for all” in the US is not going to be medicare for all….
It is going to be the “VA for all”.

Perhaps being a consultant or employee for the Gov would not be so bad, eh?

It feels like we (patients) are getting blamed for all this when we dont have a clue as to what is going on. When we are paying over 5,000.00 per year (part B and supplemental) in what is supposed to pay for doctor visits, and another 850.00 a year for Part D, not to mention what happens when we reach the donut hole, or our monthly prescriptions co-pays, even before we reach it. We are left wondering why it is that our medical expenses take almost our entire retirement, and still seems to not be good enough.

Is the Part B money being switched over and actually used to pay for Part A (hospital coverage) or just what is happening? I will be first to admit that I have used many medicare dollars, but mostly against Part A.

Also, is it an option to op out of Part B and supplemental, and send that money to our doctors directly and still keep the hospital coverage of Part A? Is this an option that would strengthen the bridge that seems to be dividing us?