Government Appreciation for a Great Family Physician

This is not a post about abstract effects of government controls on our medical profession.  This is a small note on my offense that the best family doctor I have ever met has recently been given a raw deal by the federal government.

This family doctor has been practicing family medicine for a good 30 years.  He loves being a doctor and relieving his patients of pain.  His fees are very reasonable and he takes a strong personal interest in his patients.  He takes the time to talk over how they feel and he is careful to check up on the medicines given to many of his patients by specialists, who often do not check for conflicts with other medicines the patient may be taking.  His patients respect and care for him in return.  He and my father and mother became friends over the many years they were and are his patients.  This doctor saved my father's life many times and helped guide him and my mother through the last four years of my father's life when my Dad was on dialysis due to his kidneys failing after another doctor damaged them with radiation in prostate cancer treatment.  The average 80 plus year old patient lives about 1.5 years on dialysis, but with this doctor's help, my Mom's help, and my Dad's indomitable soul, Dad lived on dialysis from 85 to 89 years of age.  My Dad died at home Christmas morning in 2007.  His doctor visited him at home on Christmas Eve to say goodbye.

In his entire career, this great man and family doctor was sued only once.  Despite that, his malpractice insurance went up by 25% from last year to this year.  He treats many Medicare patients.  Very recently, he sent in a Medicare reimbursement request for my Mom and he soon after received a letter telling him that he was being fined $3,000 by Medicare because he had allowed his Medicare registration to expire.  It turns out that a doctor taking Medicare patients not only has to put up with low payments and much paperwork, but he also has to pay $2500 every five years to register with Medicare.  Medicare had never notified him that his Medicare registration was expiring and he forgot, as a very busy man with much more important things on his mind might do, after 5 years.

Not only was he fined $3,000, but he has to reapply for his registration with Medicare and pay for that.  That may take months.  Meanwhile, none of his Medicare patients will be reimbursed by Medicare for their medical costs.  So the good doctor sent a letter to all of his patients telling them about the problem and telling them he would give them all a 25% discount until his Medicare registration is complete.  His waiting room is still overflowing with patients.  They all love him and are hardly willing to go to a run-of-the-mill doctor in order to be reimbursed.  But, the loss of income due to his discount and in the face of the 25% increase in malpractice insurance is making it hard for him to continue his practice.  Nonetheless, he told my Mom he would continue as long as she was alive, so she would never have to worry that he would not be her doctor.

Being a doctor who treats Medicare and Medicaid patients is very much as though you or I had to deal with the IRS on a daily basis.  Can you imagine the daily trauma?  Their payments for medical care are too low and they are miserable to deal with.  They turn a profession dedicated to healing pain and extending life into a drudge.  And now, ObamaCare will extend this misery for doctors.  No one seems to fully understand the role of the IRS in ObamaCare, but I sure hope that it is not such that our heroic and good doctors have to deal more often with them as well as Medicare, Medicaid, and the well over 100 other federal agencies and panels which are to play roles in ObamaCare.  Can anyone imagine the horror of having to deal with that many uncaring, mean-hearted, money-grasping, you-wait-forever, they-want-it-yesterday government agencies?

The day after my Mom dies, I hope this good and heroic man retires and says he has had enough.  No one like him should serve a day of slavery to the likes of these government bureaucrats.  Doctors have the same sovereign individual rights to life, liberty, and the pursuit of happiness that the rest of us have.  Remember, these inalienable rights are equally sovereign to us all.  There is no exclusion of doctors.

Doctors and the ObamaCare Shortage

The Medicus Firm, a national physician search firm based in Dallas and Atlanta, polled physicians about ObamaCare and its effects on them.  They reported the results in the New England Journal of Medicine.  Key results include:

• 62.7% of doctors believe health reform is needed, but want targeted and gradual legislation, not the massive ObamaCare bill.
• 46.3% of primary care physicians (family and internal medicine disciplines) believe ObamaCare will either force them out of practice or make them want to leave medicine.
• 72% of doctors believe a public option will have a negative impact on medical care.

According to the Health Resources and Services Administration of the Dept. of Health and Human Services, there were 306,100 primary care physicians in 2005 and there were 511,400 Non-Primary Care specialist physicians in 2005, for a total of 817,500.  ObamaCare will depend upon these physicians to deliver the increased medical care that ObamaCare is supposed to provide to 32,000,000 more people.  About 15,000,000 of these people are expected to be added to Medicaid, which is a program a great many physicians will not participate in now or will not accept new patients from that program.  Who does this tyrannical Democrat government think will provide these services?  Many physicians are already also declining Medicare patients, though that program has paid somewhat better than has the Medicaid program.  However, the scheduled cuts in Medicare payments even as more and more Baby Boomers will soon enter it and need more medical care must surely cause the Medicare program to shift even deeper into underpaying doctors for their services.  The huge deficit growth of the federal government must further push it to making still lower Medicare and Medicaid payments to doctors.  The terrible condition of many state governments will also decrease their ability to make their expected and required Medicaid payments.

The net result is obvious, unless you are a pig-headed, pie-in-the-sky, other-worldly Democrat!  Doctors are going to be very unhappy.  Probably more than they now think even, as the reality of these much lower payments set in, as the tangle of myriad federal agencies start giving the doctors incredible increases in paperwork and contradictory requirements, as the number of unhappy patients pile up in their waiting rooms, and as the reality of having even less time per patient than the already inadequate time now causes them to lose all confidence that they are able to do their work in a manner consistent with professional standards, they will become seriously depressed.

When their work comes to be the source of depression, many will leave the profession.  The claim that 46.3% primary care physicians will do so or will be unhappy should be taken very seriously.  Many physicians will retire early.  In fact, there is clear evidence that many have already been unhappy enough with the pre-Obama
Care medical profession that they have been retiring early already.  We can learn more by looking at the age distribution of physicians according to the Health Resources and Services Administration.

First, note that despite the growing population of the U.S. from 2000 to 2010, the number of physicians in the three younger of the five categories dropped.  This trend is expected to be the case in 2020 also.  The only age group of doctors with an increase from 2000 to 2010 is the 55 to 64 year old group.  These doctors are close enough to retirement age and probably largely well enough off, that they can readily retire if ObamaCare is passed later today, as it now appears it likely will be.  Many of these doctors will indeed retire early and that means they will not be practicing in the 65+ age category either in the near future.  Many of the doctors already in the 65+ age group will quite immediately.


Now let us look into the future to the 2010 projection.  Note that the projection is rather optimistically expecting the future number of physicians in the 55 - 64 age group to remain as high as it is now.  This would mean a larger fraction of those in the 45 - 54 age group will continue on into the next age group than did in the 2010 case.  Given the effects of ObamaCare, this will surely not be the case.  This number will drop considerably relative to the prediction here.  It will also be insane to believe that a larger fraction of doctors will continue to practice after age 65 than did in 2000 and 2010 after ObamaCare comes into play.

The bad news does not end here.  There is another contribution to decreasing services which we are facing even without ObamaCare, which is going to make ObamaCare much less supportable.  To quote the Health Resources and Services Administration:

Currently, one in four physicians is female, but two factors are contributing to a rise in female representation. First, during the past three decades the proportion of new medical graduates who are female has risen from 10 percent to close to 50 percent. Second, the growth in female representation is a relatively recent phenomenon, and it is predominantly male physicians who are nearing retirement age. Although one in three active male physicians is age 55 or older, only one in eight active female physicians is age 55 or older. Because work and retirement patterns differ systematically for male and female physicians, the increasing proportion of physicians who are female has profound implications for the overall supply of physician services. Female physicians are more likely than their male counterparts to choose non-surgical specialties and to spend fewer hours per year providing patient care. They are also less likely to work in rural areas, and they tend to retire slightly earlier.

So, the increasing shift to more female physicians was going to lead to a smaller supply of medical services in any case.  Now, ObamaCare will chase more doctors out of the profession on top of the smaller numbers of younger physicians already and the larger fraction of female physicians who will work shorter hours and retire earlier.  This smaller pool of available physician manhours will be deluged by much more demand from aging Baby Boomers and from the greater demand brought on by ObamaCare.  The consequence will be that the quality of health care must degrade rapidly.  It will also become much more expensive, or degrade still more rapidly.  The law of supply and demand can never be denied.

We were already staring severe problems in the face.  ObamaCare is clearly going to make those severe problems catastrophic problems.  It will not be long before we really will have to be pulling the plug on granny much earlier than we have in the past.  Obama lied about this again just yesterday.  A lot of Baby Boomers are soon going to be very expendable.  Severe health care rationing is coming.  It probably was coming to some extent anyway due to the Medicare and Medicaid programs and the Baby Boomer demand increase, but ObamaCare will have to make this much more severe.  This will not be because anyone really wants this, except Obama and the Emanuel brothers, but because the Democrats do not think anything through and do not care about the constraints of reality.  They are simply other-worldly people.

A Mayo Clinic in Arizonia Stops Treating Most Medicare Patients

The Mayo Clinic facility in Glendale, Arizona has stopped treating many Medicare patients as part of a two-year trial program.  The Mayo Clinic is known as a high quality, relatively low cost provider of health care and was praised by Obama in June as a model for efficient health care.  Yet, the Mayo Clinic, based in Rochester, Minnesota, with a staff of 3,700 physicians and scientists, treated 526,000 patients in 2008 and lost $840 million on Medicare patients.  The average loss per patient was $1600 and many of their patients were not on Medicare, so the loss per Medicare patient was higher.

According to the March report of the Medicare Payment Advisory Commission (MPAC), doctors made 20% less treating Medicare patients than they did caring for privately insured patients in 2007.  Of course, this is like getting an estimate of future costs for a government medical program from the CBO.  As is well-established historically, the CBO estimates are always many times less than the future costs actually turn out to be.  The underpayment estimates of the MPAC are just as surely underestimates.

Socialists like to claim that Medicare is a huge success.  It would in fact be an obvious total failure, except that many of its costs have been transferred to patients on private insurance and the fact that demographics have allowed it to operate successfully as a giant Ponzi scheme so far.  As the Baby Boomers reach the age of 65, the program will rapidly incur costs which will exceed the current income from the Medicare payroll tax.  This will happen by 2017 or even earlier by 2013 in some estimates.  Some combination of higher taxes, lower medical services payments, and rationed medical care will have to make up the shortfall in the program's ability to pay for medical services.  The day of reckoning is very near and the present socialist Democrat health insurance reform bills are not addressing any of the real problems, except perhaps on the pathway of rationing future health care.  In many ways, the present ObamaCare bills actually add to expenses directly with taxes on medical services and will add further with an incredible overload of bureaucracy and innovation restrictions.

The Glendale Mayo Clinic facility has more than 3,000 patients eligible for Medicare.  They will have to pay cash to continue to see their doctors there.  This facility lost $120 million in 2008 on their treatment.  Only about 50% of the cost of treating elderly primary care patients at this facility was paid by Medicare.  There are a few areas in which Medicare payments will still be accepted there.  Specialist cardiology and neurology services and laboratory services payments will still be accepted.

Medicare covered about 45 million Americans at the end of 2008.  About 92% of family doctors participate in Medicare, but only 73% of them or about 2/3 of all family doctors are accepting new patients under the program.  The increased numbers of patients over 65 in the next few years will result in a further reduction in the percentage of family doctors accepting new Medicare patients.  If payments are cut back, as they likely will have to be due to the coming funding crisis for Medicare, then the percentage of doctors accepting Medicare patients will drop still further.  There is already a severe shortage of family doctors at the present time, so the situation will deteriorate catastrophically.  Congress, just about a week ago, postponed a 21.5% cut in Medicare payments to doctors for two months.

Yes, this is the farce the socialists are telling us is a great and successful program.  In fact, it is as bad as the post office, Amtrak, the ethanol from corn subsidy program, and subsidies for wind and solar power generation.  Well, except that the failure of this program will have fairly immediate deadly consequences for very large numbers of elderly Americans.  At the same time, it will most likely add still more backbreaking taxes upon younger generations, who will also be struggling under the huge increases in health care insurance premiums which ObamaCare will require them to buy for themselves.  Some very nasty intergenerational warfare is going to result.