We saw a clinic doctor refuse a new Medicare patient today.

[madfloridian]

On Edit: I am not blaming doctors, I am blaming the ones who let the programs for seniors start deteriorating. I do blame the receptionist for being cold. Also on edit, I have been amazed today at how many do not think the Medicare and Social Security programs are that important.

Now that I have seen this first-hand, these articles take on more meaning. It is scary, and it gives a hopeless feeling. It was done by the receptionist in a cold and uncaring way, almost off hand. She just told that person that doctor was not accepting new Medicare patients. When that person questioned, she said that was all she was going to say.

Where are the advocates for people feeling this pain?

http://www.signonsandiego.com/news/northcounty/20060108-9999-1n8cuts.html

Medicare patients seeking their first appointment with family practitioner James Hay in Encinitas are being told to find another doctor.
Same thing for Medicare enrollees trying to become patients of Dr. Carol Young, a rheumatologist in Escondido.

Hay and Young are among doctors nationwide who are rejecting new fee-for-service Medicare patients because they're fed up with the government's reimbursement rates. A 4.4 percent cut went into effect Jan. 1.

http://www.newyorkmetro.com/nymetro/health/features/14788/

In 1989, New York became the first state in the nation to make public the mortality rates of its heart surgeons. Report cards for two different procedures, coronary bypass and angioplasty, were chosen as the standards by which the entire profession would be judged—a sort of litmus test for the skill of a given surgeon or hospital. The mortality numbers, risk-adjusted by age and other factors, are released every year or so on the Internet and reprinted in newspapers for all to see, hospital by hospital and doctor by doctor. Ending years of private, clubby surgeon culture, the public report cards were intended to shine a light on poor surgeons and encourage a kind of best-practices ethic across the state. If the system worked, mortality rates would fall everywhere from Oswego to NYU.

But the statisticians who devised the report cards have been tormented by a persistent, intractable glitch in the system: It involves human beings. From the start, it was clear that surgeons’ careers were on the line as well as patients’ lives, and even before the first set of data was released, leaders in the heart-surgery community warned with an air of eerie certainty that the threat of public exposure would create a chilling effect—influencing surgeons to turn their backs on the sickest patients in order to prop up their personal success

http://www.acponline.org/college/pressroom/patient_access.htm

Medicare Cuts will Accelerate Looming Crisis in Patient Access to Primary Care
ACP Witness Expresses Perspectives of Young Physicians in Testimony to House Energy and Commerce Committee
November 17, 2005

(Washington): Medical students and young physicians are turning away from careers in primary care medicine, and Congress must act now to stabilize Medicare payments to physicians as a first step to avert the looming crisis in patient access to primary care that this will cause.

What else is there to say? It is happening, and no one is speaking up for them.

[Jim Sagle]

1. Doctors like that need their licenses pulled.

[KatyaR]

16. I agree, but this has been happening for years.

There's a whole group of doctors who refuse anything but cash services--you are responsible for filing for reimbursement from your insurance company. Many of them have also refused to take Medicare and Medicaid patients precisely because of the low reimbursement rates and the large hassle factor involved.

It's been this way for a long time. It's just that a whole new group of people are getting slammed.

Don't worry--in five years none of us will probably have health insurance . . . .

[tirechewer]

24. The hospitals are doing something similar

My mother who had Medicare and a supplemental plan, had a massive stroke two years ago. I called the paramedics who took her to the nearest hospital, a huge non profit institution which was not hurting for money. The ER doctor said she needed to be put in a room in ICU. The hospital stuck her in a room on a geriatric floor where she was monitored sporadically because of a 9 to 1 patient to nurse ratio. My husband and I provided many of her personal hygiene services because the nurses staff simply could not do it. This was true of many families on that floor.

Her first night which was most critical we could not find a nurse to hook up her naso-gastric tube so that she could have suction to keep her lungs clear. We were frantic and went and screamed at the head nurse until she went and did it to make us go away.

She managed to hang on for 10 days. The nurses were very good to us when they could be, and tried their best to help her, but she developed pneumonia because of the absence of suction her first night and then a septic infection. About 7 days in she had a second stroke. We could see what was happening but we couldn't get anyone to help her because staff was so thin. When they did come they finally were able to scrounge up portable telemetry to monitor her, but it was too late. She died three days later. We had gone to the hospital administrator and threatened to sue him, so on the day she died he agreed to have her moved to ICU where she should have been all along.

One of her nurses told me that it was always understaffed on the geriatric floor and that someone in my mother's condition should never have been put there. I know she had a massive stroke. I don't know if she could have made it in ICU. I do know that she would have had a better chance there. I know from the nurses that they hated having to under treat Medicare and Medical patients, but that the hospital had mandated how they could treat the patients.

I didn't sue anyone. Money was not going to replace my mother, but I did complain to the state board which regulates hospitals. They said that they could not tell hospitals how to care for individual patients. They simply regulated overall treatment standards. No one cares for individual patients if they are old, or poor, or have Medicare instead of private insurance.

While we're thinking abstractly about what Bush is doing to Medicare and how this has been happening for years. let's also think personally of what this could mean to our parents, other relatives and ourselves. Because we are all going to get old one day, and I doubt that many of us are rich enough to bear the cost of our own medical care. I saw the future in that hospital, and it sentenced many people to death.

[madfloridian]

25. That's a sad story.

People are forced onto Medicare at 65. Then they are forced to be treated like that, even with a supplement.

I am finding out that many people here at DU do NOT know the difference between Medicare and Medicaid. Someone even asked why in the world would someone go on those programs.

How can they not know when they, their parents, and grandparents will be on Medicare for sure. And some on Medicaid because of disability, etc.

[tirechewer]

26. Thank you....

for the kindness in your reply. You're right about Medicare and Medicaid too. My husband worked at Social Security for over 20 years, and I think some of it rubbed off by osmosis, so let me have a whack at explaining.

Medicare is an entitlement program which is paid for by taxes and by premiums taken out of Social Security and Social Security Disability awards which are based on the beneficiaries' earnings. The amounts of the Social Security awards are based on their 40 highest quarters of work, adjusted for inflation, paid when they are eligible for retirement or when they can no longer work due to disability. It is called an entitlement program, because it is based on the beneficiaries' own earnings, and not awarded because of lack of assets or work.

Medicare was originally designed to work the way private insurance plans do, as a fee for service plan which allowed the buyer to choose their own medical professionals and medical facilities. Up until recently, it lacked any type of prescription coverage. What Bush calls prescription coverage is a farce, and the beneficiaries are forced to pay an additional premium for opting in. As far as I am concerned Medicare still lacks any kind of prescription coverage.

Medicaid is a state supplement designed to work with a federal needs based program called SSI, which is not funded by Social Security. It is paid for entirely from general revenues. SSI covers only people who are aged, blind and disabled and who have limited income and resources. Some people who are eligible for SSI are not eligible for any benefits from Social Security. Others are, but their Social Security award is so low that they cannot live on it. They always must be aged, blind or disabled. SSI adds enough to a low Social Security award so that it will equal the monthly SSI amount. When you are on SSI you are also entitled to basic Medicaid coverage. Most states, but not all, add supplemental coverage to the basic Federal coverage.

SSI does not bring entitlement to Medicare, unless the individual has earned it along with Social Security. One exception to this is SSI recipients over 65. They are permitted to buy into Medicare Part B coverage, which covers medical services other than hospitalization. The state pays the premium.

Many states also have names for Medicaid. In California, we call it Medi-Cal. Medi-Cal is very basic. It pays for some prescriptions, but only those which are listed on a formulary. It pays copayments and coinsurance. The biggest problem with it is that it is entirely up to an individual doctor whether or not he will accept Medi-Cal. Many do not. Many of those that do provide less than optimal care.

Illegal aliens are not eligible to Medicaid or SSI. In most cases, they are also not eligible for Social Security and Medicare, even if they work and pay in FICA taxes. So much for the big welfare giveaways.

People have a lot of contempt for those who survive on SSI and Medicaid, but it could happen to anyone. My husband had a case involving an upper-middle class family whose teenage child was assaulted and left severely brain damaged. This child had to be institutionalized, probably for the rest of his life. His parents' health insurance ran out after awhile, and they used up their bank accounts paying for his care. Eventually, they filed for SSI and for Medi-Cal for this child, who now has his medical care paid for, and a very small allowance to help cover personal necessities. It's there when you need it, if you have a profoundly disabled child, or an elderly parent whose Social Security is low, or if you yourself become disabled before you can establish entitlement to Social Security.

I've said it before, and I'll say it again. No one gets through their lives without some kind of trouble or illness. Showing compassion to them by letting them continue their lives with some kind of independence and dignity, is the only thing that makes us different from hyenas. Or Republicans.

[xray s]

2. Bush is trying to destroy Medicare

There can be no doubt about it.

Republicans want to kill Medicare.

[boobooday]

3. Wow. Compassion.

But it is hard to hold the doctor responsible. I'm sure he or she is swamped.

Our health care system is crap.

[msgadget]

4. My mother's friend, a Medicare recipient, had to leave the

hospital because of a past-due bill. Seems she couldn't afford the premium on a co-insurance policy that would've covered her medical expenses (a little bit) better and the money from her pension and Social Security barely cover her needs. This isn't how the most powerful nation (??) should treat its elderly. Yes, she worked. Yes, she saved. She got old. She got sick. Both very expensive hobbies.

[jwirr]

5. Hold on! Doctors and other health care providers have

always been able to refuse to take Medicaid and Medicare. This was happening clear back in the 1970s. Usually it does not matter because most doctors do take them. This is not a repug issue.

[madfloridian]

7. I think it is Democratic issue, don't you?

I think Democratics should be front and center on this. But yes, I blame this heartless bunch of Republicans in power for most of the outrages going on right now.

You confuse me though. Where did I say it was just a Republican issue?

And don't you care?

[jwirr]

17. I have had to use both programs most of my life. It is not new

and it is not something that is part of todays issues.

Yes Democrats should support access to universal health care but in the states I have lived the fact that a few doctors did not take the government insurances did not make much difference because for every one that refused there were two who took patients with these programs. What I meant by it not being a repug issue is that both Democrat and repug administrations have for years supported the right to refuse to take government insurance. IF we get a universal health bill through these holdout care providers will be left in the dust.

Also it does become a problem if there is a shortage of health care providers. What MN did when the poor could not find a dentist who would take them was require each dental clinic to that a % of patients on these programs. The dentist were protesting the practice of cost setting for each procedure by refusing patients.

[kiraboo]

19. Completely true. I was a receptionist in my father's office

and his partner regularly refused to accept Medicare patients. It's one of the reasons my dad eventually ended the partnership. He was actually willing to accept whatever patients were willing to pay, no matter how long it took to pay it. I remember one woman would bring in fresh vegetables and berried from her farm every week. That was how she payed for her care.

BTW, Dad's a republican, and hates GWB. While they may be deluded, not all repukes are lacking in conscience or morals.

[madfloridian]

20. You don't see many like that.

That is great he did that.

I felt so bad for the person this happened to today. We were leaving, and we saw him just sitting on a bench outside the office. He had tears on his cheek. He said he was not sure where to go next. He had just moved to the area. His wife was ill. He said he felt so helpless.

That is the worst part of what is happening now, the helplessness seniors feel. This should not be happening.

[kiraboo]

21. I agree entirely. Once we have collectively lost compassion

for those who are vulnerable and weaker than ourselves, we have lost our humanity. The F***ing irony of the shrub's administration claiming to be the guardian of the "culture of life" while allowing - no, encouraging - this sort of result, is what I find completely mind-blowing.

[madfloridian]

6. The Steady Creep Towards Concierge Medicine

Now this will make everyone howl, not just Medicare. Those who can afford the yearly fees will be happy, others will suffer if no doctor is available.

http://www.brownmccarroll.com/articles_detail.asp?ArticleID=172

"A quiet medical revolution is occurring in this country. Physicians are dropping out of managed care plans and Medicare, or continuing to participate and risking contractual and other sanctions to implement a concierge medical care model. Specifically, physicians are exploring, and in many cases implementing, a system (referred to as concierge care or boutique medicine) where private medical practices charge retainer fees for more personalized services. The personalized “concierge” services can vary greatly, but typically include periodic wellness checkups, availability during non-business hours, unhurried consultations, guaranteed “wait free” appointments, and even house calls. Concierge medicine is attractive to many physicians because in a typical scenario, a physician can maintain his pre-concierge income while reducing his patient panel by 50% or more. From a professional satisfaction standpoint, concierge medicine allows physicians the opportunity to really know their patients. "

[sendero]

8. This is nothing new..

... it's been going on quite a while now. Don't blame the doctors, in most cases they would get paid so little by Medicare that they would lose money on each treatment.

Unless of course they are specialists, in which case there is a high likelihood they are raping the system blind.

[madfloridian]

10. I was not blaming doctors. I am blaming the political parties.

Basically I am blaming the Democrats for not realizing this and for not speaking up.

So you think it is ok for them to refuse?

[sendero]

13. I think...

... that no businessperson or professional will be in business long if he collects less money for his services than they cost to provide.

Most doctors take on a certain number of these patients and then only replace the attrition. They cannot afford for their practice to be 50% Medicare patients.

[madfloridian]

14. So you don't think there is a responsibility for our seniors..

and our disabled somewhere along the line. You really misread my post, anyway. I am blaming politics and corporatization for this. Where did I blame the doctor?

[sendero]

15. I must have...

.. I certainly believe that health care should be a basic right, as it is in any civilized country.

But the OP made specific mention of the receptionists manner. What else is she going to do?

[baldguy]

9. Our health care systems is shaped by market forces.

There are those that can pay and there are those that can't. Those that can't suffer & die.

God bless America!

I was listening to a local radio station today with a supposedly "liberal" host who spent the hour slamming the whole idea of a single-payer system. She told of a friend in the UK who had to buy extra private coverage because she didn't feel the National Health she got was good enough.

My only thought was "So what? Everyone gets a minimum amount of coverage, and if you want more you pay more. That's how it SHOULD work."

The difference is that in the US, some people get the medical care they need and others simply don't - in countries with universal coverage you may have to wait a while to be treated - BUT YOU *WILL* *BE* *TREATED*.

[madfloridian]

11. So we are not our brother's keeper anymore?

That is what I am gathering from the posts here today. It is business, pure and simple.

Good luck when your parents, grandparents or yourself get to that age.

Just saying.

[dmr]

27. I wonder sometimes when I hear some people

talk about our need for health care in this country, if they've really sat down and thought about what it really means. It makes a good sound bite. We say it, then move along to the next issue.

My doctor told me in December that Medicare had reduced reimbursement for care given; and that it was going to hurt his practice. Doc told me not to worry as he would continue treating those of us on Medicare. My doctor does blame politics, and more specifically, the Republicans, for bullying and then ramming through that God-awful legislation. I agree with him. All I know is I'm paying more and more these days and it's scaring the hell out of me. And then to bring prescriptions into the equation - just one script alone costs more than 300 a month, so guess what? This ol' gal is taking one less med.

My mother passed away 10 years ago. Her Medicare HMO was Cigna. She had been in and out of the hospital. One day when she was admitted to the hospital, we reminded them she needed to continue to take Lasix or she would go into CHF (congested heart failure). Despite our multiple pleas, the doctor told us she didn't need it; sure enough, mom suffered CHF that night. Mom was also in excruciating pain in her right shoulder. They told us she had arthritis, and suggested she was exaggerating her pain, possibly for attention.

To move the story along, mom was discharged, but remained very ill, and in much pain. I took mom to the large teaching hospital I worked at. Even though my hospital was out of Cigna's plan, I made up a story and told the doctors that mom started having chest pains while we were out driving around, and of course I brought her to the nearest hospital. < wink wink >

They admitted mom immediately, but only after my hospital's vice-president spoke with Cigna, telling them she could not be moved until she was stabilized. It was nice that this man went to battle for mom, I went to him after the nurse, and then the doctor could not convince Cigna to let her stay. I just knew something was wrong, something other than her heart. They had mom's medical records sent from the other hospital for review.

Do you know what they found? Mom was in the advanced stages of lung cancer! After all her previous hospital stays, they NEVER informed her, let alone her family. They played God and decided to just let her suffer and die! That excruciating shoulder pain was the cancer that spread to her bone! They never gave her a choice, but the most cruel of cruel was purposely making her suffer from the worse pain ever, then telling all of us her pain was exaggerated! They just let her suffer!

Once Cigna got found out by my employer, they couldn't do enough good things for mom. She got the royal treatment. Mom was immediately placed on morphine, started chemo, soon after placed under the care of Hospice, and in less than two months died, in dignity, at home with her family by her side.

I wanted to hold Cigna's feet to the fire and see an attorney, but my family objected. They felt Cigna made up for their 'crime' by ending up doing good by mom. Either they failed to realize or didn't care that mom was not an isolated instance. I am of the firm belief that mom was purposely denied Lasix. I believe the idea was for mom to suffer from, then expire from CHF, relieving them of the high cost burden. I find that criminal.

I know this is anecdotal, but once we look at the anecdotals, we can definitely see the patterns. We are all only good for the profits we can bring in, and seemingly dispensable if we interfere with those profits. Somewhere, we need to find our conscience. All this pro-life, morals and compassion that is spoon fed to America daily isn't getting us anywhere.

I'm reminded ... I remember back in the 80s many of the for profit hospitals in South Florida were competing for one group of Medicaid recipients. That was the maternity patient. Hospitals remodeled their maternity wards and fought for these Medicaid moms-to-be, including offering free gifts. This was when they started what we use to call 'drive-by' births. In one day, out the next. No more two or three day stays. But once those high Medicaid dollars dried up, those very hospitals closed their doors to these patients - they were only good for the profits.

< sigh >

[McCamy Taylor]

12. Feds giving big $$$ to RX Co.s, pennies to providers. They know

that someone will see the elderly. They are careful to keep the premiums at a kind of rock bottom that is just enough to ensure that some patient mill somewhere can afford to herd them through like cattle---or, their long time doctor can continue to see them out of sense of charity without losing too much money because he or she sees lots of other people on regular insurance. That is the position I was in when I was in private practice. As long as I didnt take new Medicare patients, I could continue to see my regular panel of patients including some Medicare and Medicaid patients (and other patients who changed to Medicaid and Medicare while I was treating them). But there was no way I could handle the volume if I had opened my practice to all the Medicare patients who needed new doctors when their physicians' retired. I would have had to send the rest of my patients away. My practice was basically full at that time anyway. Eventually I closed to all new patients.

Now, new physicians are another matter. As long as new docs come out of residency, they will take new Medicare patients. But if med students dont go into primary care because reimbursement is really, really bad, then you get a primary care crisis. And the feds know what they have to do.

[TheBaldyMan]

18. Oh boy, another victory for the 'monitor everything, manage nothing' crowd

These managerial geniuses have been let loose on my (British) NHS and they have reduced efficiency and soaked up funds that could have been spent on clinical needs.

[OzarkDem]

22. Some of us do every day

For the last 2 -3 years, I've seen a drastic increase in doctors who refuse to treat uninsured cancer patients unless they come up with cash for their chemo treatments (which often run to $3,000 or more per treatment). Patients will go for months without treatment while trying to get cash together from friends and family. Its a race they never win, and most end up with mets and die.

Women who have suspicious mammograms but have no health insurance often can't get a doctor or hospital to give them an appointment for a biopsy (if they diagnosed them they are obligated to treat them).

In our 12 county area, there are probably at least 10 of these cases a month. What happens? People die.

Wake up DU, this is real.

[caligirl]

23. The shame of the nation: why we need better health care and how to get it

By Ethel Long-Scott, WEAP
San Francisco Bay View
March 22, 2006

-----------------------------------

This month millions will watch “Miracle Workers,” ABC’s newest reality show, where dedicated professionals provide quality care to a select few “deserving” cases who cannot afford it. The four-year-old with the life shortening spine problem. The blind father who will see his children for the first time – all “miracles” that should be commonplace care for everyone, every day

Across our nation, up to 100 million people are being left sick, stressed-out and in pain because of inadequate health care. Many of these conditions are confounded and in many cases caused by living with inadequate housing, low wage jobs, malnutrition – all problems easily addressed if we prioritized our domestic needs.

The failure of this nation to invest in its people was brought home in shocking clarity when we all watched the tragic events in the Gulf last year. Neglected levees burst, drowning thousands and displacing hundreds of thousands. Now, imagine one hundred million more abandoned by a system that refuses to do as virtually every other industrialized nation has done worldwide: provide adequate healthcare and basic living conditions for all of its residents.

On Saturday, March 25, hundreds of Alameda County residents, health workers, organized labor and other concerned folk are coming together to discuss how poverty and the health crisis is affecting our communities and what can be done to make a difference.

The hearings represent an unprecedented collaboration between organized labor, low wage and no wage workers of all colors around shared interests in economic and health justice. “We are all in the same boat,” says SEIU 790 Education Director Karega Hart. “The system hurts health workers. It hurts patients, and it hurts low-income communities even more. These hearings are a way of telling our stories so that those in power can hear them.” “Making the invisible visible,” says Nancy Lewis from California Nurses Association and SEIU 790. “It’s about forging solutions.”

We don’t have to settle for horror stories like what happened to Portia Anderson, an Oakland breast cancer survivor whose job provided no health insurance. She grew increasingly frightened as private medical agencies kept insisting, month after month, that she would have to pay for them to examine a growing lump in a breast. Every step along the way the demand for money was put over what she needed to save her life.

Ultimately it would be a women’s health clinic who took her in and referred her to a public hospital. In her story on our website, she notes a five-month delay between getting diagnosed and getting treated. “Had the cancer been very aggressive, I would probably not still be alive,” she said.

More than 50 years ago, the United Nations declared adequate health care to be a fundamental human right. It is the responsibility of governments to make sure that people can claim their rights. The right to health means access to medical care, an adequate standard of living and a clean, safe environment. The United States is not meeting that responsibility.

Countries like Canada and Australia spend less than half of what the U.S. spends per capita on health and are statistically healthier. The republic of Korea and Costa Rica, countries with fewer resources and a lower average standard of living, achieve comparable health indices on well below $1,000 annually per person. In the richest nation the world has ever known, health and health care are getting worse, and as employers cut health coverage, the number of uninsured grows.

In our most impoverished communities from San Diego to Redding access to preventive health care has been cut off. More and more of us realize that this is a life and death crisis. Martha Kuhl, board member from the California Nurses Association, is hopeful. “We are coming together to discuss and promote important solutions such as H.R. 676. The time is now for us to work together for a future that brings everybody in and leaves no one out.”

Ethel Long-Scott is executive director of Women’s Economic Agenda Project, www.weap.org. WEAP is also the host and coordinator of the Poor People’s Economic Human Rights Campaign. She invites everyone to the Citizens’ Hearing on Alameda County’s Health Care Crisis, Saturday, March 25, 10 a.m. to 2 p.m., at the Forum Building at Laney College, 10th Street entrance, 900 Fallon St., Oakland. Congresswoman Barbara Lee will open the event. For information, call [phone].
http://www.calnurses.org/media-center/in-the-news/2006/march/page.jsp?itemID=27596995

[bobbieinok]

28. in an OK town with many retirees, many drs were refusing to accept

new medicare patients....this was reported ca 5 years ago as the 'tip of the iceberg'