Going to the Doctor
My father now jokes that his time is structured only by his doctor’s appointments. He is exaggerating a bit, as fortunately he is relatively healthy and active. Because he has been self-employed for more than three decades, he always had to buy his own health insurance until he qualified for Medicare just a couple of years ago. As he got older, his premiums grew so large—despite no major health problems—that he would buy a policy with a very high deductible, which is only useful for catastrophic illness.
So while reaching that 65-year milestone might have been difficult for some people, he was relieved to finally have affordable health care. I notice he is much better about getting regular check-ups and is far less concerned about costs. Out of habit he still asks how much procedures will cost and I have to remind him that he need not concern himself with those things anymore. It’s very likely that he is healthier now than a few years back now that he does not hesitate to visit the doctor.
Just a few weeks ago, he found out that one of his long-time physicians was retiring. As is common in this scenario, the doctor gave him a list of others in his specialty that he could switch to. Some of the doctors he called were closed to new patients. More troubling, several on the list told him that they do not accept Medicare.
Unfortunately, this is not a new problem. USA Today ran a story on this issue back in 2001, and A News Hour with Jim Lehrer featured the problem in 2002. But it is new to those just beginning to rely on Medicare, and there will be many more people facing this issue as the "Baby Boom" generation retires in larger numbers each year. The reluctance of some doctors to accept Medicare comes at a time when health care costs are rising. The New York Times recently covered this issue, citing that average insurance premiums have doubled since 1999, and approximately 57 million people live in families where health care costs cause significant financial strain. Couple this increase with the massive layoffs Americans are facing, and we are left with a potential health care catastrophe.
I am fortunate to have good (although not cheap) health insurance coverage with my employer. But even people with insurance are not immune to high costs of health care. One of my doctors announced last year that they would no longer be an “in network” provider. They would still accept health insurance and bill my carrier as a “courtesy” to me, but I would have to pay the full cost of the visit up front and they would reimburse me whatever my insurance company paid them. I had to wait months (and make a few phone calls) to get my money back, and no longer had the benefit of a pre-negotiated rate for my office visit. A major benefit of health insurance is that the doctors in their network agree to accept the rates the insurance company determines to be fair and reasonable. Instead, I had to pay about four times as much for my check-up as I did the year before.
We should also consider the doctor’s perspective here. My doctor’s office had previously been overflowing with patients, and I knew whenever I had an appointment I could be in for a long wait. She was always apologetic about being late, and she seemed pretty stressed out from rushing from patient to patient. After the change, she was much more relaxed and the waiting room was all but empty. It’s likely she has fewer patients but earns the same if not more with less stress.
Because insurance rates sometimes don’t covering their basic operating costs, doctors struggle financially too. Medicare is notorious for offering little reimbursement for doctors, and doctors know to expect long delays before they receive any payment at all. Factor in the cost of paying staff to fill out massive amounts of paperwork and follow up on submitted invoices, and those costs can make it difficult for some doctors to make ends meet.
Some doctors have decided not to accept health insurance at all, some charging what amounts to an annual membership fee to be part of the doctor’s practice In some cases these doctors provide additional services, including the old-fashioned house call. What might seem like the return of a quaint tradition is typically only available to those with the disposable income to afford the fees.
It is no secret we are facing a crossroads in health care. President Obama has promised to address this problem during his term, and it will be no small feat to figure out a solution. When Medicare was signed into law by Lyndon Johnson in 1965, the average life expectancy was under 70; in 2005 (the most recent year for which we have data) the age had risen to 77.8. Women’s average life expectancy is now 80. While these numbers might not seem dramatic, consider that Medicare is now covering recipients an average of nearly eight more years, and that most costs are incurred in a person’s last few years of life.
Our medical technology is dramatically different from 1965 as well; with more tests and treatment options come more costs. As our population continues to age and face health challenges, the Medicare program will likely face more difficulties. With medical advances, diseases that might have been untreatable in the past can now be treated as chronic conditions. But this ability to prolong life comes with a cost, and we need to figure out how to address that cost. If doctors can no longer afford to accept Medicare, who will care for our parents and grandparents?