Facing cuts in Medicare payments, Dr. David D. Richardson, an ophthalmologist in Los Angeles County, closed his practice last week to all but emergency patients and those needing surgery.
WASHINGTON — Congress returns to work this week with Medicare high on the agenda and Senate Republicans under pressure after a barrage of radio and television advertisements blamed them for a 10.6 percent cut in payments to doctors who care for millions of older Americans.
(..)Democrats need just one more vote to pass the bill, and they hope to win over Republicans who were hit by advertisements over the recess. The advertisements assert that Republicans have been protecting “powerful insurance companies at the expense of Medicare patients’ access to doctors.” The commercials were aimed at 10 Republican senators, including seven up for election this fall.
But President Bush has vowed to veto the bill, so the fight — and the uncertainty — could continue for weeks.
Mr. Bush and many Republicans oppose the bill because it would finance an increase in doctors’ fees by reducing federal payments to insurance companies that offer private Medicare Advantage plans as an alternative to the traditional government-run Medicare program.
(..Dr. David D. Richardson, 40, an ophthalmologist in Los Angeles County, closed his practice last week to all but emergency patients and those needing surgery.
“I love practicing medicine,” Dr. Richardson said, “but I would lose more money by keeping my office open than by pulling it back to a skeleton crew. Just like a physician in the emergency room, I try to reduce the hemorrhaging.”
In Topeka, Kan., Dr. Kent E. Palmberg, senior vice president and chief medical officer of the Stormont-Vail HealthCare system, said its 70 primary care doctors were “no longer accepting new Medicare patients as of July 1 because of the draconian cut in Medicare reimbursement.”
Dr. Gerald E. Harmon, a family doctor in Pawleys Island, S.C., said he decided last week that he would not take new Medicare patients “until further notice.”
“This is not what we enjoy doing,” says a notice in his waiting room. “It is what we must do to maintain financial viability.”
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In an interview, Dr. Barrett said: “I lose money whenever I operate on a Medicare patient. In the last week, a number of doctors have told me they will quit seeing new Medicare patients or will cut back on the amount of Medicare work they do.
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But independent studies have repeatedly found that the private plans cost the government more per person than traditional Medicare.
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On the other side of the issue, military families have joined doctors and AARP, the advocacy group for older Americans, in lobbying for the bill.
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For five years now, Medicare has been paying private Medicare Advantage plans much more per enrollee compared with what the same enrollees would have cost in the traditional Medicare fee-for-service program. The money used to pay Advantage insurers is coming out of traditional Medicare.
It's time for the Congress to examine whether the extra payments to Medicare Advantage plans are the best use of tax-payers dollars for the beneficiaries the program is designed to serve.
These payments could be used to provide better benefits, like filling in the doughnut hole and reduce out-of-pocket costs for seniors and the disabled, as well as to create a viable alternative to the ineffective sustainable growth rate mechanism currently used to determine the physician payment update.
Traditional Medicare needs to be able to compete on a level playing field with private plans, which requires the elimination of these extra payments.
It is no mystery why prescription drug costs are vastly lower in Canada and Europe than they are here in the USA. Foreign governments negotiate with the pharmaceutical companies on drug prices. The result is that the pharmaceutical companies still find it profitable to sell drugs outside of the USA at 30% to 50% discounts, compared to U.S. drug prices.
Congress created the Medicare Part D prescription drug benefit. This law did two things: it guaranteed premium pricing for pharmaceuticals, by prohibiting Medicare from negotiating drug prices, and it provided hundreds of billions of dollars in U.S. taxpayer subsidies to pay for these premium drug costs.
But Medicare is so huge that the pharmaceutical industry would not walk away from this market, any more than it walked away from the Canadian or European markets. There is no problem with drug availability in Canada or Europe, and there would be no problem with drug availability within Medicare.
Even defense contractors and space agency contractors have to negotiate pricing with the government. The only industry which apparently gets to set its own government pricing, outside of the pharmaceutical industry, is the Iraq contracting industry, led by Halliburton. Every other industry has to negotiate. Letting them simply set the price for their products is ridiculous. It is simply "pay-back" for campaign contributions.
Simply give Medicare the ability to negotiate drug prices, and drug prices for Americans will go down, while those for the rest of the world will eventually go up, and there will be a more equitable sharing in the global costs of pharmaceutical research and marketing.
U.S. for-profit health care fundamentalism has the most de facto rationing, higher rates of uninsured, exclusions for pre-existing conditions, excessive deductibles and copayments, and shorter hospital stays and physician visits. It also has the most waste on administration, billing, marketing, profit, executive compensation, and risk selection.
The U.S. for-profit health care system is good at creating new drugs and technologies and marketing them to hospitals, physicians and patients. But our health care system is not so good at simple medicine like preventive care. Our pharmaceutical-based health care system is very good at creating new health care products that will make a lot of money, and where our health care system isn't profitable, it is a total failure.
It doesn't take a rocket scientist to figure out that the United States does a good job of developing and delivering new and expensive drugs to patients, because tht is the only thing we're good at. But it'll take a rocket scientist to figure out how this makes for a better health care system.
nice find deep
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