June 7, 2002 | Commentary on Health Care
More and more of them aren't accepting new Medicare patients. Some physicians are withdrawing from the government health-care program for seniors altogether -- even though, in the words of one orthopedic surgeon, it "breaks my heart."
"These are the patients that I love to see the most," Dr.
Abraham Rogozinski of Jacksonville, Fla., told The New York Times.
"They bake you poundcakes for Christmas because they are so happy
with the care that you give them."
The reason for the physician flight: Medicare's complex pricing
system. Doctors have seen their reimbursements cut by 5.4 percent
this year, even as they're forced to comply with a growing pile of
practically incomprehensible regulations. Even the pay hike
Congress will consider soon is a stopgap solution.
In many cases, the reimbursements don't begin to cover the cost
of providing care to Medicare patients. And even if they did, there
are the regulatory hurdles: A recent American Medical Association
survey of doctors found that more than one-third spend an hour
completing Medicare paperwork for every four hours of patient
The symptoms of deep discontent are unmistakable. More than
eight out of every 10 health-care professionals say they don't
consider Medicare's fee schedules "fair," according to a survey by
Yankelovich Partners, a California-based research firm. And 71
percent said the reimbursement schedules don't ensure quality care.
No wonder 17 percent of family doctors, according to the American
Academy of Family Physicians, are refusing to take new Medicare
patients. This is a bad omen, especially since America's population
is aging rapidly. (The 77-million baby-boom generation will start
retiring in less than 10 years.)
Worse, America's doctors are being held hostage by Washington's
high-stakes politics. The American Association of Retired Persons
(AARP), for example, opposes increased payments to doctors in
Medicare unless Congress first agrees to provide a "meaningful"
prescription drug benefit -- meaning one that would cost about $750
billion over 10 years. That's almost twice as large as the leading
Senate Democratic Medicare drug proposal, and it would guarantee a
sharp increase in the program's rapidly rising costs. Seniors and
taxpayers alike would pay a high price.
How could Medicare's condition have deteriorated so badly? Its
problems are built into its bureaucratic structure. We're talking,
after all, about a system of central planning and price regulation
in which bureaucrats control nearly all aspects of the financing
and delivery of medical services. Congress and the Centers for
Medicare and Medicaid, the federal agency that runs Medicare,
dictate which benefits, medical services, treatments or procedures
will -- or will not -- be made available to seniors.
This means that with every benefit change, medical breakthrough
or technological innovation, members of Congress and the Medicare
bureaucracy -- not exactly a rapid-response bunch -- have to change
the law or regulations to make the needed changes and keep up with
the times. Medicare patients often must wait while patients with
private health insurance enjoy quicker, more reliable access to new
medical services and technologies.
The doctors who refuse to see new Medicare patients are
reacting, understandably, to the system's most inescapable
features: mountains of red tape, sluggish and inappropriate
payments for services provided, fears of retaliation for even
accidental book-keeping mistakes. That's why a short-term pay hike,
however welcome, isn't enough. Policy-makers must address the
problems at their roots with genuine reform.
Fortunately, a model for such reform already exists. It's called
the Federal Employees Health Benefits Program (FEHBP). It's a
patient-centered, consumer-driven system that covers members of
Congress, federal workers and retirees, and their 9 million family
members. FEHBP members select the health coverage they want from a
wide variety of competing plans, all of which offer solid
Congress should use the FEHBP -- the health-care program they
designed for themselves -- as a blueprint to remodel Medicare. A
renewed system, based on patient choice and a competitive market,
would enhance the quality of health care for the rapidly growing
number of senior citizens and improve the working environment for
In the short term, Washington policy-makers should boost
payments to doctors in Medicare (at the very least reversing the
latest cut). They should also intensify their review of the
regulatory burdens facing doctors and other medical specialists in
the Medicare program and give them timely relief from senseless red
In the long term, though, forget about giving Medicare a facelift. For America's retirees, their health-care program needs to be fully rejuvenated. Our seniors -- and the doctors who desperately want to serve them -- deserve nothing less.
Robert Moffit is director of domestic policy studies at The Heritage Foundation (www.heritage.org), a Washington-based public policy institute.
Distributed nationally on the Scripps Howard wire