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The Doctor Is Not In

A Commentary by Susan Estrich

Saturday, June 26, 2010

Not long ago, a close friend called me with an unusual request. She
and her husband were looking for a new doctor to take care of them. What
made it unusual was that they'd had the same doctor for years -- decades,
actually.

What happened to "J," I asked. Did I miss something in my otherwise
careful reading of the obits? Had he hung up his stethoscope?

None of the above. Her husband had turned 65 and was now eligible
for Medicare. Good news -- except "J" is one of the increasing number of
doctors who aren't taking "new" Medicare patients, or even old ones.

I remember the days when the health insurance industry used to
advertise that Hillary Clinton would take your doctor away. She didn't. But
a lot of people have lost their doctors anyway because of the PPO rules and,
lately, because doctors just don't want to put up with the rates Medicare
pays.

According to the Centers for Medicare and Medicaid Services, 97
percent of the doctors in America accept Medicare. But that is a very
deceptive number. It doesn't mean that doctors will take new Medicare
patients. According to another study, this one by the American Medical
Association, 17 percent of the doctors they surveyed restrict the number of
Medicare patients in their practices -- and that number for primary care
physicians is 31 percent. Watch out!

Some doctors get around the Medicare limits by charging for
"concierge" service. I kid you not. They charge an upfront fee for doing
things like promptly returning your calls and providing top-notch referrals,
things my own doctor (not a concierge) calls good medicine. Others just get
rid of longtime patients when they turn 65.

In an era of double-digit unemployment, it's hard to feel sorry for
people making six-figure incomes. On the other hand, many people who do work
of lesser value -- that required much less education -- make far more.

I was looking at a hospital bill of my own (from when I collapsed
on a street corner in New York City), and frankly, I was pretty horrified to
discover that the doctor who read my brain scan and concluded that, thank
God, there was no mass was paid less than the hairdresser who trims my hair.
Don't get me wrong: I like my hairdresser and value his work. But my life
doesn't depend on it.

And the doctor got more from my insurance company than he or she
would have received from Medicare. I have private insurance. Doctors get
paid, on average, 22 percent less from Medicare than they do from private
carriers. And they're prohibited by law from billing you the difference.

Obviously, we need to do something -- actually, many things -- to
rein in the skyrocketing costs of health care. As more of us get older and
the number of uninsured decreases, those costs are only going to increase.
But simply paying doctors less to do their jobs is not the answer.

Better prevention, better screening, fewer unnecessary tests and
procedures, more coordination -- all of those are important steps. But there
is something wrong when people like my friends reach their 60s and have to
find new doctors because the ones who know them best won't take care of them
anymore.

I told my friend to call my doctor, Larry. He's watching his income
being slashed, but he's past caring. He is what another doctor friend of
mine calls a "dinosaur" -- a doctor who puts patients first, even at his own
expense, which is how things work today. I am grateful to have a dinosaur on
my side. But I fear that his ilk is facing extinction, and we will all
suffer for it.

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Views expressed in this column are those of the author, not those of Rasmussen Reports.  

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