Chickens coming home to roost, Part 2

Roosting ChickensRemember those Medicare pay cuts to doctors that were narrowly averted last summer?  Remember how that was the latest in a long series of similar proposed pay cuts?  Remember how bigger pay cuts are scheduled for about 13 months from now?  Well, primary care doctors — those that remain, that is — remember too.  And according to this report by Sarah Rubenstein at the Wall Street Journal Health Blog, they’ve had enough:

Each year when doctors lobby against Medicare pay cuts, they argue that the crummy pay will eventually lead to fewer doctors to care for the elderly.

Even though the worst cuts are usually averted, the effect of the annual battle over Medicare compensation to primary care doctors has taken its toll.

Some of the predictions of access problems look like they’re coming to pass, especially for patients who don’t already have a primary care doctor when they turn 65 and become eligible for Medicare. Witness a patient who moved to suburban Washington from Chicago and had to make 12 calls before nailing down a new doctor, the Washington Post reports.

The stakes in the Medicare payment battle are high, even as broader health reform is beginning to dominate the conversation. As WSJ.com columnist and family doc Benjamin Brewer put it early this year:

While everyone’s talking about how to expand health care for the uninsured, I think it’s time to fix the Medicare system that’s leading many doctors who tend to the basic health-care needs of the elderly to reconsider the proposition.

This year, my office closed to new Medicare patients.  We get calls from seniors trying to find a primary care doctor.  When we say we aren’t taking new Medicare patients, some patients remark that they’ve called numerous physicians and can find no one willing to take Medicare.  Other patients will say things I’ll leave to the reader’s imagination.

Somewhere, there exists an alternate reality where America didn’t turn its back on primary care.  In that reality, health care isn’t cheap, but it’s cheaper than it is here.  In that reality, people aren’t all healthy, but they are healthier than they are here.  In that reality, primary care doctors aren’t rich, but they are better compensated than they are here.  We don’t live in that reality.  We could have, easily, but we chose not to.

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