By Hal C. Scherz, MD and Richard A. Armstrong, MD
70 year old woman comes into her Urologist’s office in Atlanta frantic, because her internist has stopped seeing Medicare patients. A 76 year old man in South Florida needs a hip replacement but may not be able to have surgery because his orthopedic surgeon cannot find a cardiologist who will agree to see and evaluate him for surgery. These stories are true, told to me by doctors that I know personally. They are taking place in doctors’ offices all across the country each day and they are on the rise. This is the sad reality that seniors face and it will get worse. President Obama saw to that when he signed the Affordable Care Act (ACA,Obamacare) 2 years ago.
So when, at a recent press conference, he threw down the gauntlet and warned the Supreme Court not to overturn the ACA because doing so will destroy Medicare, he has gone back to his playbook; creating a scapegoat to deflect attention away from his mistakes and shortcomings.
Medicare was already on shaky financial ground before Obamacare. With $37 Trillion in unfunded liabilities, and a growing senior population, a plan that Lyndon Johnson promised would not exceed $10 Billion in the first 10 years of the program, now costs over 100 times that amount and threatens the financial stability of our country.
The President’s health care law rocks the shaky foundation that Medicare is built upon, by diverting $500 Billion away from the program for seniors and uses it to finance the subsidies offered as part of a new entitlement program.
Clearly, the senior vote is important to President Obama, which is why he has employed the classic “bait and switch” scam. The very popular Medicare Advantage program covers 25% of elderly Americans- over 11 million. This is being phased out as part of the new law and was set to go into effect in 2012. Knowing how unpopular this will be with seniors, the cuts have been postponed and will begin AFTER the election. Meanwhile, an aggressive PR campaign has been launched at taxpayer expense, to convince seniors how Obamacare will protect their Medicare benefits. Trusted actors like Andy Griffith have been used by this administration to reassure seniors that they are in good hands with Obama. Simultaneously, the Democratic mantra is trying to convince seniors that it is the GOP who is trying to throw granny off the cliff, when it was President Obama who did so the day that he signed the ACA into law.
The problems with access to care will create a medical tsunami. There is already a critical shortage of doctors in America. Drastic cuts are in store for physicians who accept Medicare, which is why doctors have been limiting their practices to new Medicare patients or dropping the program altogether. The Medicare reimbursement to physicians is already at 60% of commercial insurance and is scheduled to be cut dramatically in the near future. This is the case, despite the fact that physician reimbursement only accounts for 9-12% of overall Medicare spending. Physicians unfortunately are what are referred to as the “low hanging fruit”- the easiest ones to target with cuts. When this occurs, your Medicare card will simply give you the right to wait in a very long line to see your doctor if you can find one.
In order to make sure that Medicare costs do not go up, the Independent Advisory Payment Board (IPAB) has been created- perhaps the worst of the 159 new agencies in this new bureaucracy. Until 2020, this new board can control costs just one way- by cutting reimbursement only to physicians and other health care professionals. Their decisions are virtually final, since overturning their recommendations requires a nearly impossible vote of 2/3s of both houses of Congress in a 30 day window. The recommendations are also not subject to judicial review. Essentially the IPAB is not accountable to anyone except the Secretary of Health and Human Services who maintains dominion over the entire American healthcare market. The IPAB decides which procedures they will and will not pay for. In this way, they can shape the behavior of physicians who are at their mercy, and they control the healthcare of seniors who are caught in a bind, because they must sign up for Medicare if they wish to continue to receive their Social Security benefits.
There have been plans that have been proposed by Congressman Paul Ryan, and by Senators Tom Coburn and Richard Burr which propose alternatives to save Medicare. These require a fundamental change in the program from that of a defined benefit plan to a defined contribution model. The idea is to put healthcare decisions back into the hands of patients and promote more personal responsibility. The key to change is the understanding that seniors currently receiving Medicare or those who are planning to go on it very soon will NOT be affected by these proposed changes. But without these changes, Medicare for everyone is projected to become insolvent by 2024 according to CBO, and likely much sooner without the cuts that have already been counted on that have yet to happen.
Seniors are unfortunately easy prey for con artists. The problem is that they take on many forms. The trick is to spot them. If a deal seems too good to be true, then it probably is. Just remember “caveat emptor”- “let the buyer beware”.
Hal C. Scherz, MD is the Founder and President of Docs4PatientCare, VP of Georgia Urology, and Associate Clinical Professor Urology- Emory University.
Richard A. Armstrong, MD is the Chief Operating Officer of Docs4PatientCare, an organization of concerned physicians committed to the establishment of a health care system that preserves the sanctity of the doctor-patient relationship.