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Tell Congress: Keep Your Medicare Money!

We don’t want your pay raise, says a leading physician group, responding to the American Medical Association’s effort to stop payment cuts scheduled to go into effect beginning in January 2006, and replace them with a pay raise.

In a memo sent to Members of Congress today, the Association of American Physicians and Surgeons writes: “Some other medical groups have been telling you that proposed cuts in physician payments will harm seniors by creating a crisis in access to physicians. But we disagree. There’s already a problem, and it has nothing to do with the new rates.”

In ads and on their website, the AMA says that its survey shows that 38% of its members will cut the number of new Medicare patients they accept if the first round of cuts goes into effect in 2006. They not only call for a halt to the cuts, but a change in the Sustainable Growth Rate (SGR) that would provide for pay raises in 2006 and subsequent years.

In its memo, AAPS refutes the AMA conclusions and tells the government they don’t [want] a pay raise, but instead lays out the case for less government interference.

“Our surveys show many physicians ALREADY refuse new Medicare patients. In fact, about 33%. But even more alarming is that 40% already restrict services they’ll perform to current Medicare patients. (See Disheartened Doctors, Patient Problems: AAPS Biannual Survey of Physicians on Medicare and Patients’ Access to Care, Journal of American Physicians & Surgeons, Winter 2004.)

“But here’s what you need to know: the reason they do so is NOT because of money. When asked, it’s the government ‘hassle factor.’ The two leading reasons given were ‘billing and regulatory requirements, and hassles and/or threats from Medicare carriers/government.’ Payment rates were down the list."  To read more, please go to www.medicaltuesday.net/medicare.asp.

Pharmacy Benefit Program

Medicare Reform – Pharmacy Benefit Program 

What Must Be Done – A Clinician's Point of View

The varying estimates on the Medicare Pharmacy Benefit Program only reveal the hazards of projecting any entitlement program. Once implemented, all government programs increase and the costs are nearly impossible to control. The additional costs to the Medicare Program are not sustainable—even in the short term. Therefore, it is urgent that the program be modified before enrollment starts next month.

When Medicare was implemented in 1965, there was a nominal deductible on hospital and outpatient benefits, with an additional copayment of 20 percent for all physician and outpatient services. Had the deductibles and the copayment remained a responsibility of the patient, Medicare would not have experienced a spiral increase, as is the case today. For instance, if every $80 doctor's office visit required a 20 percent or $16 copayment, only necessary office visits would be made. The copayment, a market restraint, would control utilization and thus costs. Oversight programs to watch and control every Medicare expense would not be necessary. External controls are never patient sensitive; while they reduce one patient’s excessive costs, they also eliminate another patient's critical test for diagnosis or treatment.

Unfortunately, the insurance industry came to the "rescue" and provided coverage for the deductibles and copayment. This totally removed Medicare from the Medical MarketPlace environment. When patients pay for expensive health care with taxpayers’ dollars, there is no longer a disincentive to overuse. The lack of market-based discipline increases utilization dramatically and costs continue to spiral upwards.

To read the entire OpED, go to http://www.delmeyer.net/hmc2005.htm

In Summary: Reinstate the annual deductibles and the 20 percent copayment for all outpatient Medicare benefits. Eliminate Medicare-HMO or MediGap insurance for those beneficiaries that desire a pharmaceutical benefit at 30 percent copayment. (Since many Medicare-HMOs are leaving certain geographic areas, this should be politically possible to implement.) Cancel the current Medicare Drug Benefit Program before it's implemented in 2006 and over the next decade save the $720 billion (or $1.2 trillion by other projectionis). This will save Medicare for our grandchildren also.

Del Meyer, MD, Pulmonologist, Sacramento

Founder and Editor, MedicalTuesday Newsletter

www.MedicalTuesday.net