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Dear Mr. Obama:

Congratulations on you victory.  It really is a great thing that you have accomplished what you have, and you are a symbol of hope to a huge number of people – both in this country and abroad.

I will never forget the look in the eyes of one of my favorite patients – a sweet African American woman in her eighties who has since passed on.   We were chatting at the end of a visit and I asked her – a woman who had grown up in the South and had seen much scorn and hatred – what she thought about a black man running for president.  A person of any political persuasion would have been moved by the way her eyes teared up and how she couldn’t find the words to explain.

The problem is that I may not be able to afford to take care of women like her in the future.  As it stands, my practice would be far better served financially to stop taking care of people like this.  I am hanging on to my Medicare patients for now, but I do it more as a social responsibility than anything else.  The only reason I can afford to do so is because we are running our business well enough that we can afford to take the small amount Medicare pays.

In the face of the potential cuts to Medicare rates, we had discussions in our practice for the first time about possibly dropping it.  We would have actually lost money to do some procedures, and barely make anything on others.  Getting rid of Medicare would not only free up space for patients with health plans that pay us better, but it would free us from the incredible rules that apply to us because we are Medicare providers (go here if you don’t know what I am talking about).

Fortunately, we got a stay of execution at the last moment, but the simple fact that we talked about it is huge.  We are doing far better overall than most primary care practices – so if we talked about it, a huge percent of PCP’s are probably far closer to dropping Medicare than we are.  The emails from companies helping doctors set up concierge practices are becoming more frequent and more enticing.

It is very discouraging to see local hospitals spending $100 million for a cardiology wing, to watch the advertisements from well-reimbursed specialists on TV, or to read about the incredible profits many companies are making off of healthcare.  All of this is happening on the shoulders of doctors like me.  The hospital admissions, referrals to hospitals, the prescriptions for long-term medications, and the orders for preventive medicine are all on the back of the PCP.  We control the cost more than any other group, yet we are the ones who are least paid and most regulated.  The money is still there in healthcare, but most of it goes elsewhere.

What I am saying is that you are living on a fault line.  If reimbursement for PCP’s goes down any more, you will speed the exodus from the profession and cause many like me to drop Medicare.  The effects would be enormous.  It costs far less for me to see a person with back pain than it does an ER or a neurosurgeon.  It is my responsibility to keep the diabetics out of the hospital and to prevent heart attacks.  Losing PCP’s will doom any chance at cutting the cost of healthcare or covering the uninsured – two things the you promised in your campaign.

Please make it so that I don’t have to face the hard decision of whether or not I should drop Medicare.  I am likely to be the last person off of the boat, so there will be many who drop it before I do.  That boat is headed for an iceberg, with the elderly and poor on board.  Saving money by firing the captain and crew is probably the best way to help things.

Dr. Rob

Tagged as: Healthcare, Medicare, PCP, Primary Care