Medicare Phase Out
Here is a story about the third largest group of primary care doctors in Houston who have STOPPED taking new Medicare patients. This decision is occurring all around the country. There are many reasons why this is happening and you probably know most of them if you read this blog. Here is a quote from the article:
The third largest group of primary care doctors in the Houston area claims the government insurer’s red tape and mandate of electronic record keeping very nearly strangled their business, so they had to act. “New burdens, restrictions on medicines we can prescribe, restrictions on labs we can do, surgeries we can refer for,” said Van Zant. And then there’s Medicare’s compensation which for Doctors hasn’t risen substantially since 2001. “Can you imagine going to the auto workers and telling them you are not going to get a raise in 13 years? It would not happen,” said Van Zant.
I am seeing this Medicare phase out happen locally. I am hearing about it all over the country. I promise you that this will speed up even more when the bureaucratic idiots figure out the fix. Why? Because the fix will include nothing about the burdens, restrictions, or pay issues. The fix will only be a law that states you cannot keep your medical license unless you agree to see Medicare patients. You heard it here first.
Compulsory care won’t work. The federal government doesn’t have to money to bribe states anymore into passing laws that they like. There isn’t a government program that pays more than it costs at this point. With upside down pensions and budget busting union contracts, federal requirements have choked out the incentive. Just about every state would do as well telling the Feds to keep their money.
The Feds don’t license doctors, states do. Doctors will move from the states that force them to work to the states that don’t. Even if somehow all of the states simultaneously passed medical slavery, there’d be a race to the bottom in quality. “Here for your free visit, m’am?”
Compulsory participation will be the way they go. Have heard that some states already do this with Medicaid.
In 1984, the Reagan administration pressured all states to increase the drinking age to 21, or face loss of highway funds. This gross overreach of federal authority will be the same basic mechanism by which states will force physicians to accept government patients (Medicare/Medicaid) or lose funding, as I’ve predicted for the past decade. This underscores that once Medicare was established, it would end up as a de facto vehicle toward completely nationalized medicine. Adopting Medicare was the greatest disservice doctors did toward their patients and doing so doomed the lofty ideals to which we still pay so much lip service.
The states will force everyone to take the killer M’s, and most docs will comply; the smart ones will then enthusiastically see those patients from 3:30 to 4:30 on Tues and Thursdays, limiting their access and turning away state auditors with polite shrugs. Later as pressure builds, states will mandate that a certain percentage of care be directed to government patients, and demand to see proof of more equitable access, with appointment calendars being appropriately massaged to protect the dwindling profitable slots, and back and forth a guerrilla effort will be waged to delay the inevitable while those able will be planning for their exit.
I agree on all counts, Pat.
The drinking age thing shocked me when it happened, because of the ease with which all of the states, even, finally, Louisiana, rolled over without a fight.
It was clear after that, that Federalism was on its way out in the US, and we’ve seen nothing to change that opinion since.
And, yes, as much as the private insurers squeeze doctors, and will continue to squeeze them more, the government will do more than squeeze – it will dictate, and will do so in response to essentially unrelated factors, such as budget shortfalls in non-medical areas of government.
Once they have a lever that they can use to compel treatment of the “M&Ms,” they will begin to use that lever randomly but progressively. You’ll be paid less and less, and monitored more and more to ensure that you’re not holding anything back from them.
Getting out is the only sensible thing to do, but we’ve all got very limited flexibility to do so. In my own case, I doubt I will live (or be able to work full time) long enough to pay off my loans, so when to walk away is really just a matter of degree – when do I want to decelerate my lifestyle and start dodging subpoenas?
If I make it to my eighties, I doubt that I’ll have the energy for it then, so it will probably make sense to do it in my sixties.
I believe that the weather in Belize is quite nice…