• The sky ain’t falling, Medicare edition

    I feel like I’m becoming a broken record here, because I keep writing the same piece over and over. Sure, the flavor and the focus changes, but the message is consistent. It’s this: people are pointing out anecdotes to show why health care reform is failing, while ignoring the fact that if you avoid cherry picking, it’s doing just fine.

    This Sunday, the NYT editorial page decided to help. This is from an op-ed on Medicare:

    In the critics’ most dire scenarios, baby boomers nearing retirement age could find that their current doctors are no longer willing to treat them under Medicare and that other doctors are turning them down as well. Those concerns have always been greatly exaggerated. Now a new analysis by experts at the Department of Health and Human Services should demolish that mythology for good.

    The analysts looked at seven years of federal survey data and found that doctors are not fleeing Medicare in droves; in fact, the percentage of doctors accepting new Medicare patients actually rose to 90.7 percent in 2012 from 87.9 percent in 2005. They are not shunning Medicare patients for better-paying private patients, either; the percentage of doctors accepting new Medicare patients in recent years was slightly higher than the percentage accepting new privately insured patients.

    You have to have been living under a rock not to have heard that ANY DAY NOW doctors are going to rise up en masse and refuse to see patients with Medicare. You’ve probably read a nice quote or two from some physicians who can no longer “make ends meet” and is throwing in the towel. But the data, those that describe the whole picture, just don’t fit that narrative.

    You can cherry pick, and focus on the doctors who opt out. You can interview them, highlight them, and scream about all 9500 of them. Of course, that means you’re profiling the 1% of Medicare-eligible physicians who have opted out, while ignoring the 99% who remain in the program.

    As always, many ignore the counter-factual:

    Medicare patients had comparable or better access to medical services than the access reported by privately insured individuals ages 50 to 64, who are just below the age for Medicare eligibility. Surveys sponsored by the Medicare Payment Advisory Commission, an independent agency that advises Congress, found that 77 percent of the Medicare patients — compared with only 72 percent of privately insured patients — said they never had an unreasonably long wait for a routine doctor’s appointment last year.

    “Medicare’s access is horrible!” they shout. But they don’t tell you that private insurance is worse.


    • Those numbers quoted only paint part of the picture. The end product is care (access and quality). The numbers presented do not deal completely with the real world. A doctor can accept Medicare for a variety of reasons yet choose to decline to treat many Medicare patients. (I have a lot of apples in my refrigerator, but generally choose to serve only the good ones to my guests. In fact I eat the good ones first and leave the bad ones behind. If I have no good apples I might be forced to eat a few not so good ones. But good and bad apples remain in the refrigerator and I accept both.)

      Better comparisons would be the amount of physician time spent on Medicare patients (excluding all the churning) under Medicare. Looking at just the elephant’s trunk doesn’t describe the entire elephant.

    • No, private insurance in not worse and self-pay is the best.

      You try sailing around the world with your family for two years. You will be liable for Obamacare premiums or Medicare premiums, or pay a penalty for opting out. Now try finding a doctor in the Pacific Islands who takes Medicare or Obamacare! Or anywhere outside the USSA except for Guadalajara.

      You could get private insurance of some kind, of course, but you could also pay for good, cheap care out-or-pocket. Socialized medicine is a prison.

      • Jimbino dude, you just make it up on the fly, don’t you? Americans living abroad for 12 months are essentially exempt from the PPACA. Medicare part A covers inpatient care abroad. Medicare part B doesn’t cove outpatient services outside of the US, but it’s optional anyway. But seriously, if all we have to worry about is the situation of the ex-pats and the bros, we’re good. We don’t need to go back to the good old days when sick people just died and didn’t make a fuss about it. Also, too, Google is your friend.

      • “You could get private insurance of some kind, of course, but you could also pay for good, cheap care out-or-pocket.”

        Maybe. Two of my advanced practice nurses had major injuries out of country. They had to wait until they got back to the US for definitive treatment.


    • MIllions of Americans under age 65 do not have to worry about whether doctors will accept their health insurancce.

      Why? because their deductibles are so high that they are paying for most office visits in cash.

      Medicare Part B has a miniscule deductible, I think about $150, plus 20% coinsurance.

      I think that doctors should be allowed to balance bill seniors for office visits. That will solve the access problem for most seniors in a fortnight.

      If a wealthy Medicare beneficiary has to add $100 to the Medicare payment to see a specialists, who cares? Seniors are so vastly pampered as compared to younger Americans.

      I know that my examples do not cover all situations or all seniors. I am only trying to make the point that when seniors sneeze, some commentators declare a blizzard.

    • Here in southern California seniors are gold. Medicare pays promptly and doesn’t play games (although cross them and they will put you in jail – we had a mad scramble a few years ago when one of our local oncologists got sent on a vacation to Lompoc), but in some very limited areas access is a problem. Isolated wealthy areas like Santa Fe NM, Santa Barbara, CA and the like do have access problems and not everyone who lives in those cities is wealthy. Again it’s like Jimbinos bris and ex-pats problem. A fewpeople are hurt, but the vast majority are helped.

    • J_Bean Dude:

      Though Medicare in So Cal is great, there is an apparent lack of training in reading and logic.

      You talk of expats, who are American resident abroad. In some cases, being residents, they may be exempt from Medicare and Obamacare. But I cited the case of a family sailing around the world. They are NOT expats, any more than a backpacker in Europe heading for Thailand and Japan is an expat. The sailors and backpackers, being residents of the USSA, WILL be fully liable for Obamacare premiums and either paying Medicare premiums or penalized (some 1% per month for suspended Part B Medicare premiums) if they should re-enroll on their return to the USSA.

      Furthermore, I spoke of docs abroad not taking Medicare. You responded by talking of Medicare Part A, which has NOTHING to do with doc payments. That would be Part B, which is NOT available to the backpacker, the sailor, or the 180-day month sojourner in Rio.

      Your brain is so confused that I can only suspect that you were consulted in the design of Medicare and Obamacare. So what if a few free-spirited Amerikans get crushed, maybe even a few Jews? The SoCal White gated-community set will be fat and happy!

      • Except you’re conveniently forgetting–or willfully ignoring–that Medicare doesn’t just help the “SoCal white gated community set.” The program was created to overcome a persistent failure in the health insurance market for the elderly. Prior to Medicare, those who are elderly, especially those who were elderly and poor, found it nearly impossible to obtain medical insurance. Without insurance, they had difficulty paying for medical treatment, and this was in a time when the cost of care was much less.

        After all, why would an insurance company sell insurance to someone whose care was potentially going to be thousand or tens of thousand of dollars per year, on average. And if the company would sell the coverage, it would be more expensive that most people would be able to afford.

        • @Bryan: ” Prior to Medicare, those who are elderly, especially those who were elderly and poor, found it nearly impossible to obtain medical insurance.”

          That is not quite true. Health insurance was in its infancy. The number of old people on insurance was increasing as were the number of young getting insurance. The non elderly poor don’t get Medicare. There were plans out there at the time to provide health care to the poor (that I guess led to Medicaid). The intention of those plans were to cover the needy. Medicare would cover the Rockefeller’s, so the intent of Medicare was quite different than many of us assume.

          If you look further back to the depression hospital insurance was offered by BC so that BC could be guaranteed an income.

      • In order to keep Medicare costs down, I have no problem with Americans wealthy enough to go on around the world cruises needing to find some way to make payments to physicians. The really expensive part, hospitalization is already covered. They can pick up the rest.


    • Both Steve and J_Bean are all wet. Medicare Part A is NOT available overseas. But what does work overseas is the IRS, which lays claim to taxes on any income you derive overseas while you are busy paying for private care yourself!

      If I were a young man, I’d get the hell out, as Saverin did. The only solution is to renounce your Amerikan citizenship and take, for example an Ecuadorian one, which can be gained in one year.

      • Jimbino, though I don’t agree with all you say or the way you say it your discussion of renouncing citizenship is an important thing to consider. Very few people have renounced citizenship though I think the numbers are rising. People say who cares, but they forget who is renouncing citizenship. Money, big money. Facebook’s partner renounced citizenship before receiving his undisclosed portion of Facebook. When billionaires leave even in small numbers it depletes tremendous amounts of capital and potential know-how from our society. That problem increases as the benefits of being an American citizen decrease.

        I had this discussion with a neighbor of mine who is a billionaire many times over and owns businesses and land all over the US and the world. The last time I spoke he was considering giving up citizenship since he lives all over the world anyhow and can visit the US even without citizenship especially since he has multi million businesses in the US.

        I don’t advocate this solution, but it exists whether one likes it or not.

    • Yes Emily,

      I have to consider how little Amerikan citizenship offers me. I was born in Paraguay and have a nice home in Brazil. I will still get my Social Security and even Medicare Parts B &D (if I choose), no matter where I have permanent resident status. I wouldn’t be able to vote for Tweedle Dee or Tweedle Dum, of course, but, in compensation, I wouldn’t be bothered by jury duty.

      I could do my technical translation work anywhere, and my skills in nuclear weapons and missile design would be useful in many countries I can think of. It’s a great boon not to have to repay the 27 years of mostly free schooling I have enjoyed!

    • The National Center for Health Statistics periodically maintains a “National Ambulatory Medical Care Survey.” It includes an assessment of whether or not Office Based Physician Accept New Patient — By Payor Type. http://www.cdc.gov/namcs.
      Between 1990 and 2009 for Medicaid, a decrease from 73.4% to 64.5% occurred. If you have Medicare and qualify for Medicaid (Part B and Part D) coverage, the decrease in physician availability for Medicaid would affect a large number of citizens on Medicare.

      I sit on a Medicaid Managed Care – Physician Advisory Committee convened by the local UnitedHealthcare division. We meet every three months and have very meaningful discussions about the affairs of the Plan. One issue continues to be difficult for us to consider. How can we adapt to promote equitably available and culturally accessible (EA/CA) health care for the impending expansion of citizens with Medicaid, especially in face of a declining physician resource? Omaha is probably in good shape because of having two Medical Schools here and our State government is fiscally responsible. There are large sections of our Nation where is is far from their reality. I am troubled because there is no national strategy to solve the EA/CA crisis.