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Jerry Aragon Ph.D (Phunny humor Doctor)

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Medicare: (DOA) Dead On Arrival?
by Jerry Aragon Ph.D (Phunny humor Doctor)   
Not "rated" by the Author.
Last edited: Saturday, February 18, 2012
Posted: Saturday, November 27, 2010

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Is Medicare dead-on-arrival? It's anyones guess. I'm a veteran, with over 18 years at the VA Medical Center in Albuquerque, New Mexico. I've been screwed at the VA so many times, that I couldn't wait to get out of the VA! But, it took my 18 years to do it, and a two year waiting period on Social Security on a disability. So...what's the difference in the taxpayer's paying through the VA or through Medicare?

While at the VA and being a veteran, I got everything free of charge.  When I made the move to get out of the VA, I now have to pay for my medical costs myself, and I think everything has been reasonalble, so I don't mind.  You see, the VA in Albuquerque, is a training hospital...and you know the old saying, "you get what you pay for." 

With the move to a private HMO in the community, I have to pay for Medicare each month, and I pay a co-payment for my doctors visits, medications,etc.  I made the move in the spring of 2008, and it's one of the best things I ever done for myself.  If I wanted to get murdered...or WORSE...I would have stayed at the VA.  I had to decide to make the move, while I'm fairly young at the age of 65...as to letting it go until I become senile at the age of 80 or over...I was not going to do that. 

The past 18 months at my new private HMO, has been much better, and I feel like we've gotten a lot done.  I'm one of the few veterans that can compare the services offered by the VA and the private HMO's.  I've wanted to leave the VA since 1992, and that alone will tell the reader, how much I wanted to leave the VA. 

But, the federal government in in trouble, no matter which way you go.  The American government is simply drowning in red ink, and the Congress and the White House have to apply evergency treatment, so there's going to be less for everyone in the future...and a lot of belt-tightening, etc.  In my view, it's going to be tough times for young and old alike in the future...

In my four years of writing, I have written over 215 articles, and about 20 or so, are the type where I quote from the article itself, to get the information right, and to spread the word, because I think the importance of the topic, etc.  That is the case here, and the following piece was written by N.C Aizenman of the Washington Post, and the piece was published in the Albuquerque Journal on November 27, 2010.  The piece is entitled;

"Doctors Shift Away From Elderly"  and the sub-title reads; "Medicare Cuts Make Some Change Gears"  The article reads as follows...

"WASHINGTON; Want an appointment with kidney specialist Adam Weinstein of Easton, Md.?  If you're a senior covered my Medicare the wait is eight weeks.  How about a checkup from geriatric specialist Michael Trabos?  Expect to see him every six months.  The Alexandria, Va. based doctor has been limiting most of his Medicare patients to twice yearly rather than the quarterly checkups he considers ideal for the elderly.  Still, at least he'll see you.  Top-ranked primary care doctor Linda Yau is one of three physicians with a District of Columbia internists group who recently announced they will no longer be accepting Medicare patients.  'It's not easy.  But you realize you either do this or you don't stay in business,' she said. 

Doctors across the country describe similar decisions, complaining that they've been forced to shift away from Medicare twoard higher paying privately insured or self-paying patients in response to years of penny-pinching by the Congress.  And that's not even taking into account long-postponed rate-setting method that is on track to slash Medicare's payment rates to doctors by 23 percent on December 1, 2010. 

Known as the Sustainable Growth Rate, or SGR, and adopted by Congress in 1997, it was intended to keep Medicare spending on doctors in line with the economy's over-all growth rate.  But after the SGR formula led to a 4.8 percent cut in doctors' pay rates in 2002.  Congress has chosen to put off the increasingly steep cuts called for by the formula ever since. 

This month (November, 2010)...the Senate passed its fourth stopgap fix this year...a one-month postponement that expires Ean1, 2011.  The House is likely to follow suit when it reconvenes next week, and physicians have been running print ads, passing out fliers to patients and flooding Capitol Hill with phone calls to persuade Congress to suspend the 25 percent rate cut that the SGR method will require next year. 

Such reprieves have increased the potential pain down the road, compounding not only the eventual cut but the cost of doing away with it for good...now estimated in the tens of billions of dollars.  The lobbying blitz by doctors also comes amid concern in Washington that Medicare spending is increasing so fast the nation can't afford to boost it further by significantly raising doctors' pay.  And, government anyalysts and independent experts suggest that although doctors could not absord a 25 percent fee cut, the claim that they have been inadequately compensated by Medicare until now is wildly exaggerated. 

Among the top points of contention is the complaint by doctors that Medicare's payment rate has not kept pace with the growing cost of running a medical practice.  As measured by the government's Medicare Economic Index, those expenses roase 18 percent from 2000 to 2008.  During the same period, Medicare's physician's fees rose 5 percent. 

'Physicians are having to make really gut-wrenching decisions about whether they can afford to see as many Medicare patients,' Said Cecil Williams, president of the American Medical Association.  But statistics also suggest many doctors have more than made up for the erosion in the value of their Medicare fees by dramatically increasing the volume of service they provide...performing not just a greater number of tests and procedures but also more complex versions that allow them to charge Medicare more money. 

From 2000 to 2008, the volume of services per Medicare patient rose 42 percent.  Some of this was because of the increasing availability of sophicated treatments that undoubtedly save lives.  Some was because of doctors practicing 'defensive medicine'...ordering every conceivable test to shield themselves from malpractice lawsuits down the line. 

'Then you have doctors who order an MRI for an unremarkable headache or at the first sign of back pain,' said Robert Berenson, a Commissioner of the Medicare Payment Advisory Commission, an independant congressional agency.  'It's pretty well documented that it doesn't help patients to have those scans done in these cases.  But if you have the machine in your office...why not?'

Whatever the cause, the explosion in the volume of serivces provided helps explain why Medicare's total payments to doctors per patient rose 51 percent from 2000 to 2008. 

A review of physicians' incomes suggests that specialists...who have more opportunities to increase the volume of the serivces they offer that primary-care doctors...reaped most of the benefit.  On average...primary-care doctors make about $190,000 a year.  Kidney specialists $300,000, and radiologists close to $500,000.  Figures that reflect the income doctors receive from both Medicare and non-Medicare patients.  The disparity has prompted concern that Medicare is contributing to a growing shortage of primary doctors. 

Still...even if primary-care doctors had to rely exclusively on Medicare's lower payment rates their incomes would only drop about 9 percent, according to a recent study co-authored by Berenson, who is also a fellow at the nonpartisan Urban Institute. 

'The argument that doctors literally can't afford to feed their kids if they take Medicare's rates is absurd,' Berenson said.  'It's just that doctors have gotten used to a certain income and lifestyle.'   Regardless of their motivation, if doctors skew their patient base away from Medicare too drastically, seniors access to medical care could be limited. 

Is that happening?  Again opinions vary.  Based on its studies as well as those done by others, the Medicare Payment Advisory Commission has concluded the share of affected seniuors has been small, and perhaps most significantly lower than the share of privately insured patients ages 50 to 64 who also report access problems. 

But the American Medical Association cites a recent online survey that it commissioned in which nearly one-third of primary-care doctors said they are currently restricting the number of Medicare patients in their practice."

END OF ARTICLE;

(My Two-Cents/comments/opinions) 

I am not an economist...but simply stated, the United States is losing and has lost its place in the world...too much debt!  Unless the United States gets its house in order in a hurry, there may be serious consequences for everyone...young and old alike!  The national debt must be brought down, and it will take everyone to sacrifice to do it. 

Let's face it...Medicare is 'easy money' for everyone...including greedy doctors!  As they say in Ireland...the American taxpayer is getting it in the arce

In 2010, it's scary for everyone...young and old alike.  The young have to get jobs, to be able to pay into the system which may not be there for them.  Social Security and Medicare may not be there for them, and that's a realistic thought to chew on.  The reckless spending by the government of the past has to come to a stop, of the United States will go under for sure. 

A few years ago, I saw the comment on ABC but the reporting doctor, as to what will fix Medicare.  He said that the only way Medicare could be fixed, was to turn around the ratio between general primary doctors...and specialists. In other words...there are now more specialists in Medicare who get paid more.  That has to turn around for Medicare to survive...there has to be more generalists (instead of specialists) in Medicare to survive. 

So, from reading this article...it sounds like the main problem with Medicare...is a 'doctor problem' and not so much fraud or anything else, as we are all led to believe. 

One of the first things that happened to me, after I left the VA Medical Center, was that I met with my primary doctor (who make less), but I was referred  to see three other specialists, who make more money.  The doctor on ABC may be right...there are too many chiefs in Medicare...and not enough Indians! 

These issues are enough to worry the young and old alike...for if Social Security and Medicare become insolvant...what is a 70 or 80 year-old to do? 

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Copyright; 2010; Jerry Aragon/The Humor Doctor
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