Doctors driven to ‘bankruptcy’
Only good will keeps Medicare running financially, a doctor visiting Hawaii reports
America's health care system is surviving on the good will of doctors who are caring for patients despite below-cost government payments, says the American Medical Association's president.
"If we looked at this from a business standpoint, it makes no sense," Dr. William Plested III said in an interview here during the Hawaii Medical Association's annual meeting this past weekend.
"They're (doctors) driving their own businesses into bankruptcy."
Medicare plans to cut payments to doctors by about 40 percent over nine years, starting Jan. 1, while the cost of providing care is estimated to increase about 20 percent, Plested said.
Most doctors have taken huge cuts already, he said, pointing out Medicare payments are the same now as six years ago despite higher costs.
"What message is our government sending to physicians of America?"
Most independent or small-group physicians feel they owe it to their patients to continue even when they are not making money, Plested said. "But how much are you going to hurt your practice before you say you can't do this?"
Seniors nationwide will have increasing difficulty finding doctors who will take Medicare patients as already inadequate reimbursements are sliced, Plested said.
Hawaii will lose $490 million in federal funding for the state's 166,800 Medicare patients over the nine years, according to the AMA.
Access to health care also will erode for 150,609 military families and veterans in Hawaii, as well as those nationally, because Tricare, the federal health service program, links its payment rates to Medicare, AMA points out.
"Tricare is a huge dilemma for a physician," Plested said. "Young people who are protecting this country, making a huge sacrifice, are tied to a horrible medical system. ... It's just unbelievable that we would put them at risk."
He said the AMA is trying to lead the effort for change, but "it's people who are going to do it."
The United States is not the only country with a health care crisis, Plested said. He was recently in Ireland, which has a fully government-supported health system, and the average emergency room wait was 25 to 35 hours, he said. "Cost is swamping the government and it's cutting back."
Plested described "a tsunami of two huge forces: technology and demography."
People are living longer and want more medical services, which technology has made possible, he said. But fewer people are paying for it, he said. "We just can't afford it."
Plested suggests charging Medicare patients more for health services to those who can afford to pay for them and drawing up a list of services that can be offered to those who cannot pay anything. "We need a definition of basic good health care we need to guarantee to everybody."
Oregon conducted such an experiment to hold down runaway Medicaid costs, and "the public bought into it," Plested said. A panel of citizens listed all possible medical services and ranked them according to necessity, he said. The line was drawn according to the state's Medicaid budget.
"Everybody bought into two basic facts," Plested said. "We can't give everybody everything and people need help. What can we agree we're able to do?"
