Wednesday, February 17, 2010

Dear Medicare Patients,

After February 28, 2010, I (and A LOT of other doctors) will be unable to see you.

This isn't your fault, but on that day Medicare will be cutting doctor reimbursements by 21%. Superimposed on the 15%-20% cuts already made at the start of the year, this will bring the reimbursement rate for your care to where it's LESS than my overhead for the time needed to see you. So I won't be taking any new Medicare patients.

You may be wondering how this happened, but don't go blaming this administration, or even the previous one, or congress, or the guys who write medical coding books, or the cycles of the moon, or whatever. Annual cuts have been programmed into Medicare for a long time (Medicare uses a formula that gradually reduces doctor reimbursements over time, ignoring the obvious fact that overhead costs will increase due to inflation) and the government (both parties) kept finding ways to do creative financing to work around them. After all, it's easier to put a band-aid on it then to actually fix the underlying problem. The problem with creative financing is that it's a house of cards, and sooner or later it falls apart.

And right now BOTH sides aren't doing a fucking thing to try and prevent these cuts from happening. Oh, sure, they pay some lip service and form committees, but lets face it: It's so much easier to argue over REAL issues, like gay marriage, school prayer, who's fornicating with who, if a guy on the other side is wearing unpatriotic cuff links, and whose fault everything is, than to actually try and solve minor problems like trying to keep the health care system afloat in the long run.

This isn't about the government. It's about your insurance. If any insurance company cuts its payment rates below what my overhead costs, I drop that insurance. Medicare is just another insurance, regardless of who's running it. I know this may surprise you, but I have to pay office rent, and staff salaries, and my own mortgage, and all kinds of other things. If I'm not making money, then I can't stay in business to help you. I didn't get into this job to get rich, but I do have to support my family.

So when you can't get in to see a doctor next month, I'm sure you'll find yourself saying "Well, I can't find anyone to treat my Parkinson's disease, but it doesn't matter because I know it was SO much more important that my legislators spent their valuable time arguing for/against gay marriage than trying to maintain jobs and health care."

I'm sure some of you will be angry at me, but look at it this way: If you ran Local Grocery, and had to pay $3 per tomato from a farmer, and the best price you could sell them at was $1, you'd either stop selling tomatoes or find another farmer.

Some of you may elect to pay cash to stay with me, and I'll be flattered.

Some of you will be pissed off (after all, it's just totally unreasonable of me to want to support my family), but I'm sure you'll find another neurologist. Some sucker who thinks he can make a fortune by collecting Medicare patients: all he has to do is make it up in volume. So he'll see 4 new patients in an hour OR 12 follow-ups in an hour. And you'll wait 3 hours in his lobby reading a 1987 issue of People magazine, and when you do get in to see him he'll give you exactly 5 minutes of his time to listen to your story, examine you, and decide what he's going to do. And don't expect him to have time to answer your questions.

You get what you pay for.

Yours truly,

Ibee Grumpy, M.D.


webhill said...

Now, I'm not THAT old (actually turning 40 this week) but I remember when I was a teenager, my mom would send me to the doctor with a check. I'd see the doc, go to the front desk, get a bill, give them the check, they'd give me a form. Mom would submit the form to our insurance company, which would reimburse us for part (not all) of the bill. Sometimes mom would argue with the insurance company and get more of the bill covered. Sometimes it didn't work and we had to pay more than she wanted, so then she'd "check with" the doc's billing person, to see if they were "sure it was right," which they usually were. So the insurance saved us some money, yeah, but it didn't cover the whole bill, and no one really ever expected it to. If you added up our savings over the year, it came out to more than we paid in premiums, most of the time, so whatever. When did people decide that health insurance was supposed to cover the whole bill? That's what I can't figure out. It just seems to me that if a doctor charges $120 for whatever, and the insco says "reasonable and customary" is $42, then the patient pays $78 or finds someone who charges less.

Anonymous said...

and some south of the boarder make fun of our Canadian universal medical coverage' I don't pay a nickle for my visits

Anonymous said...

Anon 5:40...hope the medical system is superior to the educational system that taught you to read and write.

Pattie, RN

Cheryl said...

You are probably better off without the pissed off patients anyway.

I am so tired of people expecting something for nothing. Sheesh. No wonder you bee grumpy.

Julie said...

nasty situation ... for all concerned.

Anonymous said...

We get reimbursed for a lot of medication at below cost in the pharmacy, but, due to the stupid NHS contract we are not allowed to refuse any prescriptions, so we just have to loose the money. We have a stupid system at the moment where every pharmacy added together is allowed to make a fixed amount of profit, if we make more, then they take it back. what they dont factor in is that they are continously allowing new pharmacies to open up, meaning that the fixed amount of profit must be split between more and more of us.

Anonymous said...

To anon 5:40 and for that you get taxed at an ungodly percentage of your take home pay. and for that your citizens hope a ferry or drive into MY COUNTRY to get the healthcare they need at a timely pace you can have you health system I would prefer non socialist taxation

Grumpy, M.D. said...

Come on people, there is no reason to make this an ugly dispute.

There are good and bad things about all health care systems. And anything else, for that matter.

Matt M said...

Let me see if I have this straight. In order for Congress and the adminstration, now and for many years in the past, to say that: "Medicare is not going to go broke," they had to rig up this payment system. Whenever the Future became the Now they would put in a short term fix. This is in order to avoid the $Trillion changes that the system really needs.

Is that the story?

Grumpy, M.D. said...

Matt M- you are correct. It's been going on for quite a while.

Traditionally it happens in December, when both sides suddenly reach a last minute agreement, and cheer that they saved the system (for another year) when all they've done is CANCELLED the cuts that we're scheduled to happen.

And they use all kinds of "budget restructuring" gimmicks to do this, figuring that someday someone else will fix the problem in the long term. Because it's easier to procrastinate and make it someone else's problem.

Keebee16 said...


Matt said...

I'll second the Amen! Sad but true. Wrote my senior thesis on Medicare, and found out a lot of scary stuff. Those buffoons in government have got to fix this bullshit. I'm sure you realize that if you accept cash as payment from Medicare patients, you'll be kicked out of the program (I think for 2 years...can't remember), as it's considered bribery and is against the Medicare rules. Probably fine with you but just beware.

Maybe by the end of the year when ppl over 65 are having a damn hard time finding a doctor who will accept them, something will finally happen...

I agree, congress gets paid way too much to fiddle with the frivolous issues you mention.

Anonymous said...

I wish they'd just set up a situation where you could go and say, "I give up. I can't take anymore" and just check out. The thing I dread/ fear most in the world is being unable to care for myself and dependent upon others who will let me lie in my own waste or suffer because its more humane than to put me out of my pain. Is that so much to ask?

Grumpy, M.D. said...

Matt- Yes, you leave Medicare (or stop accepting Medicare assignment) and you can't sign-up again for 2 years.

ERP said...

If you stop accepting a Medicare patients though you may have a shortage of patients - depending on where you practise. Around where I practice, the elderly dominate every aspect of health care so unless you are a plastic surgeon, Peds, or OB, you really can't get by without accepting straight Medicare.

Anonymous said...

Hi Dr Grumpy. Thanks for a terrific blog.

I have had the pleasure of living in both Canada and the U.S. (California) and experiencing both medical systems.

My impressions are:

a) my taxes did not differ very much between California and BC, Canada. Every state's tax system is different. It is not worth trying to compare US to Canada taxes. There are simply too many regional differences.

b) In both places, I paid for medical through my taxes. In California, I was unable to access the Medicare that I was paying for because I made too much money.

c) In both locations, I pay for medical healthcare on top of my taxes. Here in BC, I pay about $135 per month for my family. In California, I was covered by my employer while my wife and daughter were not. It was $600 per month for them.

d) In both locations, I have received excellent healthcare. In California I experienced difficulty in finding a doctor. Where I live in Canada, I have not (perhaps because I have a lot more choice -- not having to find a doctor affiliated with a particular health insurance plan).

e) The striking difference I experienced was the amount of hassle and paperwork associated with claims.

Sorry to ramble on, but it seems to me many opinions about medical in Canada and the US are informed by sensationalist media coverage. It's just so much more complicated than a 30-second sound bite on TV.

Mop said...

How does Medicare work? Do all people over 65 automatically get Medicare, even if they worked their entire lives? Or is Medicare for lower income people?

So do employees who used to be covered under Company group insurance get screwed over when they retire and move to Medicare coverage?

What other insurance options do old people have? I'm not in the medical field, but I'm just asking for my future & my parents. Thanks.

Anonymous said...

Thank you Anonymous at 7:47. It's nice to get a little perspective from someone who actually has comparisons.

outre said...

Good for you. I mean, bad for the patients but you can't operate a business(which some people seem to NOT understand, medical practice has overhead just like any others business...) on declining income.

Hopefully people remember high school economics and direct their anger at the right group instead of you for daring to not see them at a net loss. How dare Dr. G not take my insurance anymore! I pay him a $10 copay!!! (Yeah! enough to buy paper and ink the middle of nowhere hospital wasted faxing you bazillion copies!)

Anonymous said...

Just noticed that even the "ads by Google" felt obliged to chime in on this one.

The add appearing on my screen below the post is:

Low Cost Manure Spreader

Patented Grinding Drum Disperses of Manure Evenly.
Would love to know what keywords caused that one to be shown...

Anonymous said...

In response to Cheryl;

I am a new recipient of Social Security Disablility. The other day I recieved a letter in the mail telling me I qualify for Medicare now. My monthly payment would be 15% of my monthly income. I've chosen to stay with the group plan I have that is the same cost, but slightly better coverage.

I want to point out though not everyone on medicare is "expecting something for nothing". While I recognize that many recipients of medicare don't pay, please remember not to generalize.

I happen to be lucky that I have a group plan, because I have been denied all personal insurance (due to pre-existing conditions). If I did not qualify in this group plan, medicare would be my only choice, and I would be judged by people, just as I see happening here. Except, I would be paying a hefty price tag to be judged as someone "expecting something for nothing".

Moose said...

Mop - Medicare is available to people 65 and over, and people who the feds consider disabled. You apply for it, just like any other program.

The program for poor people is called Medicaid, and it's perpetually full. States get limited funding for Medicaid and the slots fill up rapidly, almost always with families with children.

If you're single and disabled with no income, like me, you wait for the feds to declare you a cripple and hope you don't get seriously ill before you can qualify for Medicare. But now it looks like even if you do qualify you still won't get medical help.

Remember when people were accusing some of the politicians working on national health plans of scheming to limit the care of the already sick and elderly? Yeah, I think they're already doing that.

No jokes today. I've been ill and I have no health insurance. I'm really not in the mood.

Anonymous said...

I see there's one comment berating the NHS, but, at least everyone gets treated, no-one gets turned away even if you are the homeless person who came into A&E on Saturday having defecated all over yourself then, as you were unable to take your jeans off (you were too drunk to undo your shoe laces), you decided to try and burn your underpants off resulting in 3rd degree burns to your leg and the worst smell I have ever encountered. God bless the NHS. Oh and generally - I think it's fair to say - that pharmacists make a tidy amount of money in the UK!

Dr Grumpy, great blog, keep up the good work!

Anonymous said...

This does not surprise me, but it does
scare me. Not at that age yet. I
always assumed that when that time comes social security will be gone. At
this rate so will medicare! My husband is a contracter and does not get health benefits. At this time we
pay $1500 a month. We are members of an HMO and I cannot switch to a cheaper insurance because I am considered un-insurable..migraines! I
have tried. The only reason we have the WELL known HMO is becaused I COBRA-ed it. I tried for a cheaper
option with HMO got same
if I lose it, we are screwed. Something really NEEDS to be done.
Apologies for the vent.

Anonymous said...

I wrote to my congressman about this and he wrote back saying that the Medicare reimbursement issue needs to be included in our larger dialogue about reforming our health care system. What a weak response but not surprising because he is dingbat Nancy's little lapdog. I am scared to death that my husband won't be able to see the specialists he needs to see!

shocked said...

Good grief! People pay $1500 per month on health insurance and some people think TAXES are too high? Holy frak - I cannot imagine coping with that kind of situation. That is just wrong. Far better for me to pay a little more in taxes in Canada then for families to face those kinds of costs. (Begin "Health care is a right, not a privilege" rant...)

anon at 02/17 8:57 - My heart goes out to you.

student dr. blaze said...

Aww, you're not going to let them pay you in tomatoes?! ;-)

I applaud your letter, Dr. Grumpy. I'm taking a Business of Medicine course right now and rationally, anyone who heard the information we're being taught would run away from medicine like s/he'd run from a terrorist with a bomb on fire in his pants. Medicine no longer makes ANY financial sense.

Oh, and it's who is fornicating with whom, btw. ;-)

Gen said...

The legislators in my state (MI) get lifetime health benefits after serving just 6 years. Somehow I don't think they have the proper motivation to fix healthcare.

Anonymous said...

How long will it take a doc to opt out of Medicare if the cuts go through? How long after that will he be legally required to treat them to avoid abandonment charges?

ndenunz said...


There was no 20% cut Jan. 1st. It was postponed until March 1st.

E&M codes went UP about 6% in exchange for doing away with the codes for consults.

Nevertheless, I suspect many people think that Dr.s still make too much money. They have no idea as to the expertise that is required nor the stress that it engenders.

BTW, I, too, no longer accept new Medicare patients because of these shenanigins.

Anonymous said...

I am very grateful when I find health care providers willing to take on my somewhat complicated issues, for the token amount that Medicare (and Medicaid when it's worth meeting my $340 monthly 'deductable' (spend-down)) pays.

When I found my current providers, I was shocked to realize that I didn't need to schedule appointments several weeks in advance, or wait over 4 hours to be seen. I was also surprised that my visits were considerably longer than 5 minutes.

Also Knowing that I can be seen within 72 hours, AND speak with someone who remembers me from one visit to the next, keeps me out of the 'er' or 'urgent care', because I know I will be cared for. I've never trusted anyone I saw at a Medicare-Mills.

Finally, as a family of two, with an 'income' of under $1200, I am far more likely to make payments on care, when the co-pay is low. I can send off one or two $15 or $20 payments and feel like I'm contributing, as opposed to seeing a $70 or $140 bill and weighing that bill against, say catching up on gas or electric. Purely psychological, but paying off more bills feels better than partially-paying a larger bill.

Doris said...

I once saw an endocrinologist who took no insurance at all. Everyone paid cash. He was so good (and was so hard to get in to see), that I never heard a single complaint.

Another internist I used to see had to eliminate a number of plans he took because he was losing money to see those patients. My plan, fortunatley, he still took. I changed employers and had to change doctors...I hated that.

It's unfortunate that for some people, having insurance more or less devalues the service being provided (because it's *free*). I've read enough medical blogs to know the Emergency Departments in this country are drowning in patients who think the service is *free*.

I like having insurance and a reasonable copay. It's eye opening to me to read blogs about people who complain about $4 co-pays or who abuse the system because they can. That's just not being a good member of one's community.

I don't know what the answer is. I was hopeful that a national medical plan would help what is happening in the industry, but I'm afraid that is far too optimistic.

I am grateful my 90 year old mom has gov't employee legacy BCBS insurance. My brother the pharmacist looks after her, so I know she is getting good care. I only hope I am so lucky when I get old.

Good luck on the Medicare thing.

I sometimes wish that all of our legislators' affiliations were unknown to their peers and that they could be sealed in a room until they came up with solutions to problems without all the partisan ugliness.

Grumpy, M.D. said...

ndenunz- the January cut I'm referring was the 15%-20% cut that occurred when the consult codes were eliminated at the beginning of the year, NOT the SGR cuts, which were postponed to March 31st.

The 6% E&M increase still did not make up the loss that occurred.

Matt said...

Mop, that is exactly correct: currently all US citizens who have paid Medicare taxes for at least 30 years are automatically enrolled on their 65th bday. You get your card in the mail like clockwork. There is no signing up. Every doc out there knows this--they know all their elder patients are on Medicare with rare exceptions (e.g., those in the military). If they're "maxed out," no more medicare patients can be accepted until one of them leaves town or, well...dies. It's all about economics. Docs working in hospitals on salary don't really have to worry about this.

Call any doctor's office to set up an appt as a new patient, and you'll find the first question they often ask is your DOB (no duh, it's a way of seeing whether you're a Medicare patient or not). Most private practice docs limit the number of Medicare patients they'll have on their rosters at any one time, unless they, like Dr. G, get so frustrated that they decide to throw in the towel.

Doctors are compassionate people. But they have bills to pay just like everyone else.

Dr. Cindy said...

We closed our primary care practice to new Medicare patients for the same reason. There is no way to stay financially solvent otherwise - Medicare reimburses me $3 LESS per pneumonia vaccine than I am paying not only am I providing staff time and overhead for free, I lost money every single time we gave a shot.

I refuse to treat medicine like a cattle call - I don't want to work in a Medicare Mill and focus on volume over quality - so unfortunately I cannot treat Medicare patients. The Part D drug plan that made everyone's pills "free" didn't help with the solvency of Medicare either...

Elizabeth said...

To Anon 6:51am
Actually our medical coverage is NOT deducted from our pay through taxes. There is a good and services tax on things we buy that pays for our health care.
I have friends in the US who pay over $700 a month for two people for health coverage and they still have a deductable. I don't have to pay that and there is no way I come close to paying $700 a month in health care tax on the items I buy every month.
Yes there are pro can cons to the two systems but NO ONE here goes bankrupt because they need to pay for surgery. I have never not gotten the care I needed in a timely basis.

Katharine said...

Whatever happened to following Canada?

Reality Jayne said...
This comment has been removed by the author.
Reality Jayne said...

FYI...I plan to roll over and die when it is time for me to go.

merinz said...

I guess one advantage (and there are not so many) of our social medicine system is that if the Govt don't come to the party we can always vote them out!

Cal said...

Like Anonymous at 7:47, I have lived and worked in both countries, and yes, there are pros and cons to both systems. The tax was not that high, and taxes do vary quite a lot from state to state, so it is difficult to make a direct comparison. Also insurance premiums are very high in the US so it probably makes up for the tax, but I guess it would vary from person to person. Regarding waiting lists, again it varies enormously: I know of people who waited longer in the US than I did in Canada for the same medical issues... Likewise, there are people in Canada waiting for non-urgent medical interventions that you may be able to have done following week in the US. Like with most things in life, the issue is not black and white. Regardless, I have received excellent medical care in both countries.

Anonymous said...

I am so glad I live in the UK and that we have the NHS. The system is far, far from perfect but at least it doesn't lead to the bankrupting of severely ill or disabled patients in order to pay for medical bills.

Its true that often the newest and most innovative treatments sometimes get refused here by our rationing body due to cost whereas they are regularly approved in the US. I am thinking of cancer drugs, various monoclonal antibodies, treatments for rare or obscure conditions etc but overall I much prefer our system.

I really don't understand the american aversion to "socialised medicine." To me its bizarre. Your country spared how many hundreds of billions to bail out the banks but won't spend the money to sort out the healthcare system?

Its one thing to have medical appliance and pharmaceutical companies making profits but I really don't see the advantage to having the insurance companies in the middle taking more money out of the system to pay bonuses and shareholders. Crayzeeeee.

Anonymous said...

Anonymous at 1:09PM, I totally agree. I have no idea both why my countrymen are okay with stimulus and bank bailouts (which I, by the way, am also okay with - because the alternatives were just too horrible to think about), but not with "socialized medicine" - which they already HAVE.

People who start hyperventilating when they think of their government deciding what kind of health care they get, who say government is terrible at making those kinds of individualized judgments, forget that the government already does that through Medicare and Medicaid.

On the other hand, Medicare and Medicaid *are* a shitshow.

Also, in the Canadians v. Americans fight: curling? Brooms and rocks? Seriously, who came up with this as a sport in Canada? :)

Reality Jayne said...

I gave birth to a child in a gov. run hospital overseas......Holy Hell...

Carl said...

Wait a second. Since when are equal rights, personal privacy and separation of church and State such frivolous non-issues?

Anonymous said...

Curling has a long and honourable history. It's thought that the good old Scots came up with the idea of throwing rocks on ice in the 16th century.

It also generally involves a fair amount of drinking. Not that I would really know or anything...

Anon 7:47

Max Kraut said...

I don't understand why Americans are so against looking at what works in other countries. I live in Germany and don't pay anything at the doctors. Sure I pay higher taxes, but I worked it out once, and with the free healthcare and free college education factored in, the overall costs are lower in Germany. This is why a lot of young Europeans go to the US after college (I did and racked up enough for a down payment on my house here). They pay lower taxes and have more $$ in their pockets, but once you have a family and start thinking about paying health insurance for the kids and funding their college educations, Europe starts looking REALLY good.

It's sad that Americans would rather put on patriotic blinders than push for a better system, one where doctors don't have to choose between feeding their families and helping patients.

But of course, whether two guys can get married has much more affect on their lives than whether or not they have health insurance does.

Alanda Jacobs said...

It really does depend on where you live in Canada... In Ontario, if you make over a certain amount, the government charges you an additional health tax, on top of the already annoying PST and GST, soon (if not already) to be HST, which shows up on your paycheck as a deduction... It's tiered, so the more you make the more you pay, but it is capped at a certain point... The provincial government there made their campaign promises that they wouldn't charge a health tax, and then about a month into term announced they were going to do just that... More then a term later and they're still in power... People are mooks... *shakes head*...

Meanwhile, here in good ol' Newfoundland, only seniors who 'earn' less then a certain amount get the NLPDP seniors drug plan supplement... Watching a somewhat poor 99 year old pay $100 for a 30 day supply of Plavix without complaining breaks my heart... :(

Verification Word: winty...

Cheryl said...

In response to Anonymous at 8:40:

Geez, I wasn't judging you, I don't even know you!

I was judging my in-laws!!!

MsLaurie said...

Australian here, also utterly befuddled by the US system, and why 'socialised' medicine is thought so awful.

No one here fears medical debt - it just doesn't happen. Sometimes in the public system you can wait for ages, but if its urgent, you go straight to the front of the line. My uncle, for example, had a horrible farm accident a few years ago, which involved stablisation at the local hospital, helicopter to the major city hospital, and treatment in the burns unit for around 8 weeks with skin grafts and multiple operations, and it cost him and his family NOTHING up front.

Really, why are people paying taxes if not to have the basics in life provided for?

Anonymous said...

I'm American, and a social worker, and I do believe healthcare is a right. I mean, thinking about it, not everyone is priveledged to have a body that works. It makes me sad that I have to worry about my insurence every time I switch jobs, as a young adult with a health condition. I don't have the luxary to wait until I get medicaid, and really the system is so mucked up right now that I'm not even sure it will exist in another thirty years.

I don't understand either why Americans are so opposed to socialized medicine. I wonder, do these people ever have to use our medical system? I pay thousands of dollars a year in medical costs. I don't mind paying co-pays, but it's awful to think what would happen if I lost a job in our economy.

hekates said...

We have a very expensive war to pay for, MsLaurie. I'm not "seriously" ill but have a couple of chronic illnesses. I pretty much work to pay for my meds (even with a prescription plan, it adds up) and have gone without some things because I just can't figure out how to pay for the procedure.

Anonymous said...

just have a look at the australian healthcare system...not perfect but it generally works. in a simplistic summary....
public system cost? paid for by 1.5% levy on taxable income collected thru the tax system. for those who can afford private health insurance and dont take it out ($146k annual family income) add another 1%.
cost of a doctor = 20% of a scheduled fee.
drug cost? max $23 with all sorts of support for low income earners.
emergency treatment? free hospitalization in the public sector for elective surgery? free.
private health insurance? minimum cost of around $100/month per person for a private room in a private hospital. your own doctor. a $500 once off per year co payment. other more expensive plans available to cover every need including dentistry, optical, physio etc. and copay waiver. but around $3500 a year for top of the line for a family is normal
if that is socialism at work then that's ok by me.
i think when it comes to health care, a lot of americans need to get their heads out, the sand.

belovedparrot said...

What I don't understand is why "common" people like us don't stand up and demand that Congress DO something about our health care system. How many presidents have tried and failed? From what I understand it's almost always the insurance lobbies that stop things cold. When are we going to get fed up enough and desperate enough to get off our obese American asses and work to make things better????

meg said...

I live in BC. My husband and I are middle class. We have two kids. We pay taxes- but it really isn't much of a burden.

I pay $114 a month for the Medical Services Plan (gov't healthcare)for our entire family. MSP premiums are based on your income and if you make below a certain amount (poor, student, etc...) you don't pay anything. With MSP you never pay for doctors visits, vaccines, health unit visits, hospitalization or ER visits. You DO pay for all perscriptions unless you qualify for a seperate plan to subsidize drugs (fair pharmacare). Each province is different. I believe that in Ontario you don't pay monthly it is incorporated into your income tax.

I also have an extended medical plan through work for which I pay about $100 a month for the entire family. This covers life insurance, 80% of Dental visits, and 80% of Prescriptions.

I gave birth in our local hospital twice. I received excellent care. I had several complications with each pregnancy and always received prompt diagnostics and treatment.

Without our current healthcare our two pregnancies alone would have left us bankrupt, I never could have planned for all the blood tests, ultrasounds (OB and Cardiac), specialists, V/Q scans etc...

What I don't understand about the reluctance of Americans to change is that they fear this type of system will encourage abuse. People are ALREADY abusing your system! But perhaps your current system doesn't seem to plan for this? And wouldn't the rest of Americans like to recieve the services that the losers are abusing? Without sacrificing their financial security?

Anonymous said...

First of all healthcare is NOT a right. Rights are granted in the constitution and, free healthcare aint there. Secondly, Americans dont want socialized healthcare because we aren't socialists!!!


Leah said...

I'm on TN's "enhanced" medicare called TennCare.
Some of us don't have other options. I just turned 21 in November...and have recently been diagnosed with Multiple Sclerosis. PPMS. It sucks...a lot. And I would have lost the medicare when I turned 21 had I not shed a bunch of crocodile tears to the right people.
Without TennCare, I would be unable to see a doctor or get any treatment at all. I'm a college student - poor by default - and physically unable to work a job that requires a lot of physical activity (I.E. every minimum wage job in my area).
So not everyone on Medicare is a lazy SOB just working the system.

That being said, I totally understand why Dr. Grumpy has to do what he's doing. Medicare simply DOES NOT pay what they should. They're cutting from places they shouldn't be in order to delay an already sinking ship.

I'll just say to all you healthcare reform's scary when, suddenly, you find out you're about to have no healthcare coverage. You're poor and sick, through no fault of your own, and cannot afford to see a doctor...much less pay for medication. You research your options, only to find that there are none. And that was just after I was told that some nodules on my thyroid might be cancerous. It's TERRIFYING to be facing illness and know that there is no way for you to receive treatment....meaning you just have to live with it till you are killed by it.
And I'm just 21 years old. I can't say I don't feel a little cheated.

privatepracticedoc said...

I am a doc in private practice who has been actively engaged in lobbying legislators since 2003 to fix this problem. I had reason to hope earlier in the year when the health care bill, which contained a Medicare payment fix, was on the verge of passing. Regardless of one's views on the overall health care legislation, it at least addressed this looming problem.

Now that hope has been replaced by utter frustration. As already mentioned in this blog, Medicare payments to physicians has remained essentially unchanged for the last decade, despite the fact that the cost of doing business has increased about 20 percent of the same time period. In under two weeks payments may be cut an additional 21%.

I still believe congress will step in at the last minute to prevent this cut. However, the word on the Hill is that the most physicians can hope for is a five year freeze on payments. Another five years of payments that don't increase commensurate with the cost of doing business is not a sustainable way to run a business.

I came across this blog because I was looking for any organized movement by physicians to stop accepting Medicare patients. I have not found one, but believe such an organization may have a role. After years of pleading, begging with legislators to fix this problem, I wonder if it will only be solved when seniors and military personnel lose access to care and in turn apply the type of pressure to legislators that forces them to act.

Anonymous said...

I am an American who strongly believes
that having Socialized medicine Does
Not make us socialists! In fact, it
makes us smart, willing to make sure
that people don't without Rx's because of the cost, or emergent care
because of cost. By emergent care I am not speaking of E.D visits but cancer treatment, surgury, etc. People are dying every day because they cannot afford treatment and meds.

Anonymous said...

I am an American, and DO NOT believe in Socialism.

But I do believe in socialized medicine. Because the health of it's citizens is a key part of EVERY country's economy.

I don't believe the govt should bail out car companies and banks, when the same money could be used to support the health care system, with far more dividends in the long run.

Katharine said...

Apparently Ed doesn't know much about rights. One has rights by virtue of being alive.

I suspect that is the difference between liberals and conservatives; conservatives think you only have the rights they feel like giving you, whereas us liberals are aware that all, regardless of location, have certain rights by virtue of their humanity.

Anonymous said...

A really good movie I saw helped put all this in perspective for me. It was called Sicko by (Michael Moore). Although it was made in 2007, I don't think much about the health insurance system has really changed since then. I highly recommend it for those interested.

Leah said...

I wouldn't recommend anything by Michael Moore, to be honest. But I would recommend a nice documentary named "Sick Around the World" which shows the public healthcare systems around the world. I learned SO much from this and it really changed how I thought about the whole subject - not by scare tactics or any such, but by factual knowledge. Anyone who really wants to weigh in on the healthcare reform issue should ACTUALLY know what they are talking about.
Most don't.

nik said...

Wow. This thread is fascinating. Although at times a few individuals have lapsed into stale and foolish arguments (along the lines of "you're socialist!" and it's counterpart "well, you're EVIL") it's on the right track.

I especially like Anonymous February 17, 2010 7:47 AM's comment comparing CAN vs US health based on experience. It's enlightening, and seems accurate. (I too hate when people try comparing taxes across borders...since it doesn't really work.)

I would like to tell February 18, 2010 2:09 PM that Sicko probably overplays its hand. It's not all a bed of roses up here in Canada. There are many, many good things, and some not so good things. But we're doing pretty well.

Finally, it seems to me that you all (yes ALL Americans) need to really make yourselves heard this coming midterm election cycle. Governments should be concerned about what their constituents think. Make them care. Although you all seemed to be somewhat on the right track (though potentially too expensive without as much benefit), reform may have already been blown off track (weak, spineless Dems, as usual, and 41 cynical, filibustering, power hungry Republicans in Senate). So as I said before... make them care.

I Travel for JOOLS said...

So, Dr. Grumpy, are you going to refuse to see patients with Medicare plus Medi-Gap plans? I am not yet 65 but getting close and I want to know what's happening.

Also, I want to know why it costs $45,000 for my sister to get ONE IV chemotherapy treatment for a drug that is not experimental, that she gets as an outpatient. Of course my sister doesn't pay that because she has insurance, but isn't that just a bit outrageous?

Grumpy, M.D. said...

1. Depends on the medi-gap plan.

2. No idea. But that's likely not what they are really getting reimbursed.

MelK said...

I'm not sure how many of the responses here are from those in the field of Pharmacy, but I thought that I would put in my 2 cents (this is a hot topic with many educated, interesting responses)!

I worked in a pharmacy in a small town, with many people on Medicaid (many not citizens) and was very disturbed by my time at this pharmacy. I had many older low income medicare patients that could not afford to pay for their important medications (cardiovascular drugs, antibiotics, hormones etc). Sometimes they would leave without them, which really broke my heart. Then I would get Medicaid patients with overrides on their PPI's (i.e. Protonix) that cost (at that time) hundreds of dollars, or very expensive versions of drugs that have the same effect as less expensive alternatives. If the medicaid patients didn't have the dollar co-pay then they received the drug for free! I'm not sure what the solution to this is... Sometimes the medications prescribed to these patients were the latest and greatest, touted by pharmaceutical reps, when a less expensive (generic) medication would have been better for both types of patients.

I believe that samples sometimes encourage a doctor to prescribe something very expensive and then the doctors get non-compliance when the patient can't/won't return for more, or they realize that the medication costs more than they can afford monthly. Many times the doctor has no idea what the medication costs are (they are rightly busy keeping up with the new advances in their fields).

In addition to this, the hospital in this town was always flooded with patients with little cold viruses and strained ankles; Thus causing a huge delay for people with severe injuries. It is a tough situation. To some of the Medicaid patients it makes no difference to them, whether they go to the hospital and pay nothing, or go to a doctor and pay nothing. Why wait out the weekend when you want cough or pain medicine now and it's free from the hospital? If you have to go to the drug store for Tylenol or Advil it costs money.

One thing I do NOT want people to read into this is that I am suggesting that doctors not be able to prescribe more expensive medications for those people that need them. Sometimes the less expensive, older drug really does not work as well or it does not work for that particular patient. I just hate seeing our elderly patients not get important medications. When I could, I would call the doctor for the elderly patients who were unable to afford their medication. Most of the doctors were grateful for the call and more than willing to switch out the drug, especially with a well thought out alternative. Without this interference many doctors never know that their patient can't afford their prescription. Many patients (especially proud elderly patients) will not even tell their doctor that they are not taking what they were prescribed or will not tell the doctor WHY they didn't buy it. With retail pharmacists most often being in such a stressful and chaotic job situation the doctors rarely get this important phone call.

I think it is becoming more and more understood that an ounce of prevention is worth a pound of cure. The lack of an inexpensive antibiotic may lead to an expensive stay at the hospital. A patient that can't afford a physical may lose the critical time frame to stop a preventable disease that ends up costing a fortune in care.

Insurance is a really complicated topic, other health care systems are very interesting and I think there is a lot to be learned from them. It can be hard for the pharmacists to understand the M.D.'s perspective (and the other way of course). It's even more difficult to make non medically trained politicians understand the complexity of different medical situations.

Anonymous said...

The people who are boasting about Canada and UK and Aust do not get it. Medicare *is* our national health care system. And it's cutting doctors (and the patients in the long run)to save money. And Cdn, UK, and other nations with socialized health care are dealing with humongous costs. Sweden now outsources 90% of their primary care to non-govt docs. There are long waits for care in Canada and Europe as well as limitations to such things as cancer medicines. Dr. Grumpy has to stop taking "socialized" medicine because it is breaking his bank.
So stop boasting about how good your health care is. Medicare *is* a national health care system and it's abusing our physicians.

Rob said...

Another Canadian here.

Our healthcare isn't perfect, but as was said for urgent care you get it promptly. It is mainly the more elective stuff that people may try to get done in the US (i.e. knee surgery)

When I see a doctor, I don't have to fill out endless forms, my doctor doesn't have to get approval from my insurance before doing a test or procedure. He or she just does what he feels is the best method to resolve the problem. I've had a couple CT scans, a few x-rays, and lithotripsy to break up a kidney stone...cost $0

Talking to my American friend, hospital ERs there sometimes require you to wait a few hours to see a doctor just like here. I'm also told that what you have to pay for private insurance is often close to what we pay in taxes if not more. Actually going by many numbers I see including those in this thread it is SIGNIFICANTLY more.

As far as paying taxes, nobody likes to do it but that is how you as a citizen contribute to SOCIETY. In return you get the benefits of living in a society which I feel includes fundamental human rights (and I'm not talking about your constitution but I'm sure the US founders would have rather seen everyone healthy than leaving poor people to die). I can appreciate rich people having problems paying more than the poor but maybe consider it as giving back to the society that enabled you to become wealthy!

Anonymous said...

As a Medicare patient who is young and disabled, I have a different perception of the situation. Yes our government (those with wealth and power) are consumed with making more money and maintaining power. Anytime you do not have TRUE representation in oversight, corruption occurs and decisions which require real life experience are mangled. So our government and its’ people are both responsible for this mess. To clarify, the government needs to listen to the true needs and pleas of the doctors and the people need to rally to force the government to actually create a long term plan that is realistic.
On the other hand, doctors need to think hard about why they became healers. If it was for money alone, in my book you should have been a lawyer. I know the sacrifice and many years of school you attended were difficult. In return, you should be compensated for your dedication and skill; however, I hear of a lot of doctors making 250,000 who are bitching because they are not getting what they think they deserve. Now back in the old days a doctor was paid via many avenues, from cash to livestock. He did the best he could depending on the community he lived within. Doctors were also given respect and a high social status (perks), not much different than today. Yes, please don’t think I am not sympathetic to the government’s nose being poked within your practice and treatment/testing plans. However, let me pose this question. If while attending medical school your teacher informed you that you would not be paid well but, your services would save countless people from the suffering of injury and disease; would you still have become a doctor? Or is this more a business venture than an act of great compassion and calling?
In closing, both sides need to give a little and reflect on what their true motivations are. I am tired of being in the middle of it and suffering the “blow off” from doctors. Are the doctors on the blog aware we (Medicare patients) are not stupid? We see right through the shallow exam and the token attempts to diagnose and/or treat. What has happened to the Hippocratic Oath? I guess easing the suffering of others has a price tag just like everything else in this land of capitalism.

Anonymous said...

Well I understand Dr. Grumpy, but what happened to that Hypocratic Oath? You know the one where its the patient and helping others over money? Seems to me that the rate of medical care and the hospital care are going up faster than the rate of inflation in America. If you and other doctors really wanted to make a difference you could certainly do a sliding scale fee for those patients in most need. I honestly think doctors now a days are less educated and more greedy than in the long ago past. You say you are not in this to get rich? Well Mr. Grump Doctor the doctors I see drive expensive sports cars and live in houses that look like mansions. You could do more to lobby for the changes needed to help the poor and elderly on medicare but you don't. Instead you lobby for other things that gives you and your medical associates advantage over others and sets up an elitist system designed to leave the poor sick and dying out of luck and on their own. You don't give a rats ass about your patients and I am truly not buying your BS blog here.

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