Mom vs the Medicare Monopoly
My parents are both over the age of 65 and recently retired. They are now on medicare, and have supplemental insurance as well. Both have some health issues and have long term relationships with their doctors.
Well, not anymore.
The large Medical Center that services most of the well heeled, small city where they live doesn’t accept medicare. Patients may continue to see their doctors at the Medical Center once they turn 65, but 15% more is added to the bill, and the patients are expected to pay in full at the time of service. The Medical Center will not submit claims, or do any paperwork on behalf of the medicare patient. Getting payment is the responsibility of the patient once they are lucky enough to be on medicare. As you probably have guessed, most patients can’t afford to do this and seek care elsewhere.
The closest place to get care is another city, approximately 20 miles away. There, the physicians take medicare. Most of the physicians in my parent’s city are employees of the Medical Center, and the Medical Center has enough non-medicare patients and doesn’t feel socially responsible enough to take in a portion of medicare patients. Basically, the Medical Center has a monopoly as most of the city’s physicians are employees, and the Medical Center’s position is of profitability at all costs.
The Medical Center has a stranglehold as most physicians are employees, and the city’s urgent care centers are owned by the Medical Center. The Medical Center, by turning away patients once they turn 65, demonstrates the worst model of profit driven behavior in the medical world. Rather than accepting a certain percentage of medicare patients, which is what most socially responsible physicians, the Medical Center forgets they are in the socially responsible business of health care. They elect to dump patients on the physician groups who are socially responsible.
I don’t think I would go so far as to mandate that physicians must accept a certain percentage of medicare patients. I think this would be akin to forcing car dealers to accept less for a car from those over 65 years. Instead I advocate that medicare reimbursement increase to fair market levels such that physicians are not forced in to dumping long term, long standing relationships in order to keep the doors of their practice open. And to the CEO of the Medical Center, I say–how do you sleep at night?
PS: out of respect for my parent’s privacy, I have deliberately not named the city where they live. I wish I could have, as I think this would have more impact.
I would have agreed with you a few years ago. But the reason physician reimbursement has fallen is because society is counting on physicians like you willing to kill themselves out of a sense of civic duty. I applaud these big centers( who have the economic clout to survive) saying no. Its time.
Actually if it was a truly market driven system, the center would have declined medicare, refused to submit claims, 10 yrs ago.
Individually I agree its inconvenient even tragic, but we have gotten ourselves to such an impasse,. I hope every year that the medicare fixes dont come through, and enough physicians quit medicare, that there will be some real change.
I agree with you that the market would have driven medicare out many years ago. The problem is that we are stuck in between–the government tells physicians what they can charge, but medicine is also a business. It’s a hybrid solution that doesn’t work. Thanks for your throughtful comments!