Medicare

One of the common responses on the part of the health care reformers to the townhall meetings last August was to repeat the story about the man/woman who ignorantly says, "Whatever you do, keep your hands off my Medicare!" Ha! Ha! Just shows you how ignorant these critics are: they don't even understand that Medicare is a  government program! There's obviously no reason for us to pay attention to the majority of Americans who oppose health care reform. Medicare is the most successful government program ever enacted. Duh!

Well, here's a question for you. How satisfied are patients with Medicare ... without a Medigap policy? Medigap is a supplemental plan offered by private insurers to cover the incredibly gaping holes in Medicare coverage. I am new to Medicare, because of disability, and I do not like it!

The biggest problem with Medicare is that I do not have my choice of doctors, despite the statements of our so-called health care reformers. They say I will continue to have my choice of doctors under the reformed system. But, Medicare patients do not have their choice of doctors now. The publication "Medicare and You" says they do but then qualifies the statement. Question: "Can I get my health care from any doctor or hospital?" Answer: "Yes. You can go to any doctor, supplier, hospital, or other facility that is enrolled in Medicare and is accepting new Medicare patients." The truth is that Medicare reimbursement is so bad that fewer and fewer doctors are taking new Medicare patients. They cannot afford it. They need a high volume of  patients with private insurance to make up for the losses they incur from Medicare patients.

The neurologist reputed to be the best in our area simply will not take Medicare patients. Who can blame him? The neurologist who performed my most recent EMG was only reimbursed $36 for her time. She spent more than an hour on me. It was by far the most careful, thorough, and precise of the five EMGs I've had. She earned all $336 she billed. Why should she accept close to 10% of the amount billed?

Even the Mayo Clinic is experimenting with turning down Medicare patients. They announced this week that their clinic in Glendale, AZ, will no longer take Medicare patients. This is a pilot to test whether they could do the same in other areas, too.

No, Medicare patients do not have their choice of doctors.

Besides, Medicare coverage is not all that great to begin with. Part A has a $1068 deductible for a hospital stay. That is, unless the patient has a supplemental plan through a private insurer, they will pay over $1,000 out-of-pocket. In addition, many of the services received during during a hospital stay are not covered. Who knows what my bill would have been had I been on Medicare when my appendix burst? The Medicare publications themselves recommend buying a supplemental plan to avoid that kind of potential disaster. (By the way, Medicare has a lifetime max, too, just as private insurers do. What will the reformers do about that? Are they lifting the lifetime max on private insurance only or on Medicare as well?)

Maybe these ignoramuses at the townhall meetings weren't so ignorant after all. Maybe they knew what apparently our legislators don't: that Medicare relies heavily on private insurance to succeed. Privately insured patients subsidize Medicare patients; without them physicians would lose too much money to continue practicing. Medigap plans offered by private insurers plug the gaping holes in Medicare coverage. Private insurance makes Medicare work ... when it does.