Doctors Are (still) Greatest Threat to Seniors by Pat Conrad MD

happy seniors

It’s finally springtime, the sun is out, and I should know better than to read anything about budget battles or Medicare.  Dammit.

An article in the online Fiscal Times says “Congress Medicare ‘Fix’ Could Leave Seniors Paying More”, to which my initial response was, “Good!”  The setup is that the House of Rep’s is looking at a permanent reform for the annual farce we know as the “doc fix” when the Sustainable Growth Rate alchemy says its time to give the physicians’ Medicare rate a 21% cut.  Author David Dayen says that any fix sustaining physician Medicare reimbursement  – you may want to sit down, or pour a drink – would be “terrible news for restraining health care spending (most of which goes to labor costs), and for that matter inequality (my emphasis).  U.S. doctors of all types earn about $250,000 a year on average, twice the pay of doctors in Europe.  Economists…have endorsed increasing immigration of foreign doctors to bring pay in line with international trends and save consumers hundreds of billions of dollars.  But like most wealthy people, doctors have the ear of members of Congress, and therefore can successfully lobby to keep their Medicare payments as robust as possible.”

If you have not joined me in laughing and/or screaming obscenities at Mr. Dayen by now, then I really can’t help you.  The highlights:

– A Boehner-Pelosi deal to fix the idiotic SGR process would cost an additional $177 billion over the next decade, half of which will not be offset by other cuts and just be added to the big ol’ debt.  To get the Dems on board, the GOP might agree to another $30 billion extension of CHIP for the kids, a few million of which have been added to the rolls courtesy of the ACA.

– Half of the $70 billion in actual cuts would come from providers; the other half would come from Granny and Gramps via more means testing (taking more from those with higher incomes).

– All 9 million seniors with Medigap supplemental coverage would suffer higher out-of-pocket costs.  Dayen says that “The proper term for this is cost-shifting, pushing funding for a public program onto those who get the benefits.”  Whether or not the author got that irony, he added, “All of this is being done to protect doctor salaries…Maybe Medicare doctors shouldn’t endure a 20% pay cut, but the idea that they wouldn’t see patients if the cut were 5 or 7% doesn’t pencil out.”

And therein is the mother load (no, I didn’t misspell).  I believe that this article represents a large chunk if not majority of U.S. thought regarding Medicare.  Despite decades of evidence to the contrary, the popular presumptions are still:

  • Medicare was and is, a good idea.
  • Medicare is a right.
  • Medicare is financially sustainable.
  • All doctors are wealthy, therefore…
  • …doctors can easily afford a haircut to help care for deserving seniors.
  • Doctors will take that pay cut, and keep on working.

This is what voters, politicians, and egalitarians like the author are counting on, and when enough participating physicians retire, or quit taking Medicare, they will use the “need” for a further fix as the basis to force universal Medicare participation.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  6 comments for “Doctors Are (still) Greatest Threat to Seniors by Pat Conrad MD

  1. Madelyn Sieraski
    April 4, 2015 at 1:39 pm

    As a retired physician on medicare I come close to crying every time I get a medicare EOB. The payments are outrageously low. Even worse than I thought when I was practicing. Keep cutting payments and docs will be paying the government to take care of patients.

  2. dale
    March 25, 2015 at 4:58 pm

    Well, if they really believe that we don’t have a choice but to take a pay cut, they are wrong as many like me have just said “screw it” and retired. Now I make a lot less, but travel, enjoy the grandkids and pay a whole lot less in taxes than ever before. Blood pressure gets better or goes away, attitude improves AND can get on the take rather than give side of the spectrum since that is what Mr Obama and his ilk like so much. Who knows, maybe food stamps next to pay for the steaks on the grills and the red wine to go with it. For those too young to retire, I would suggest unionization (Obama loves unions as well). And I don’t mean some wimpy thing like the AMA, or other medical organization, I think the Teamsters might be a lot better.

  3. Steven Dean
    March 23, 2015 at 4:25 pm

    We are being manipulated into a crisis mode. Led to believe that there is nothing that can be done but the “fix”. We will all feel good about the “fix”till reality sinks in and we are dependent on government intervention

  4. Bill Ameen, MD
    March 23, 2015 at 1:44 pm

    When I was a teenager and Medicare was passed during the LBJ administration, we were still able to fight the war in Vietnam, fund the moon program, and fight the war on poverty, because most people died around the age of 65 and doctors’ office visits cost $3 and a day in the hospital was maybe $100 with an appendectomy costing maybe $250. No CT, MRI, angioplasty, etc. Obviously a “fix” is needed but the wrong-headed solution is to pay doctors less…hospitals maybe, but not doctors! Increase patient copays. Maybe eventually with decreased utilization the life-expectancy will drop back down to 65 and voila! Money saved. Even Social Security is safe!!

  5. Perry
    March 23, 2015 at 10:53 am

    Seems to me this is the best way to drive physicians away from taking care of Medicare patients.

    • D Ferrand
      March 25, 2015 at 9:30 am

      Oh, they’ll still be seen….just in my ED, and with no follow up care…

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