Thursday, September 30, 2010

Unintended Consequences of Health Care Legislation

Something not particularly well known about Social Security Disability is that after two years, a disabled person, regardless of age, is eligible for Medicare. An eligible person isn't just given the option, he or she is automatically moved to the program unless he or she specifically declines it. Until that point, a disabled person usually has to make do with Medicaid and all of its maddening restrictions and budget shortfalls. One would think that the ability to transition to a better program for health insurance would be reason for celebration. In some ways, it is, but in unexpected ways, it has not proven to be been appreciably better.

As of two months ago, the health care reform plan passed by Congress and signed by President Obama cut physician payment for services by close to 22 percent. This was done in an effort to force doctors to become GPs, rather than specialists. As was talked about during the debate, there currently exists a shortage of GPs in this country, particularly in rural and remote areas. Specialists, as we know, make much more money. Cutting Medicare disbursement rates was then a means of forcing more physicians into general practice, rather than specialties. This was at least the hope of those who drafted it.

The date that Social Security deems me officially disabled for a period of two years will be on 1 October, which is tomorrow. Yesterday, I called around to doctor's offices in the Washington, DC, area and was told by three separate providers that due to the change in payment arrangements, they were no longer accepting new Medicare patients. In talking to a Social Security employee later in the day, I was informed that many doctors, specialists and those in general practice, are up in arms about this issue. Some are even considering refusing to take Medicare patients altogether henceforth. I'm fairly sure this is an unintended consequence of a massive bill that has now become law. Even those who pushed for this reform act knew that there would be need for constant modification and tweaking. Here is one such example.

Every solo or group practitioner is in business for himself for herself. Naturally, if a person can make more money as a gerontologist than in general practice, he or she probably will opt for the former. With time, more physicians emerging from medical school will probably become GPs. There are incentives included in the bill to make sure of that. But for right now, people like me have to contend with an awkward transition phase, one that shortchanges doctors and patients both. A part of me wants to rail at greedy doctors, but a part of me also knows that they have to make a living, too. In in the meantime, I bring this issue before an audience in the hopes of finding a way to reach some satisfactory resolution.

Medicare needs to cover medical services at a rate close, or even equal to private carriers. Too many seniors, and yes, disabled persons depend on it. The gap may close with time, but no one knows for sure just when that might be. A need does exist to prevent people in small towns from having to drive miles out of their way for basic medical services. During many of my prior hospitalizations, I routinely talked with fellow patients who had no choice but to drive over an hour or longer in order to be treated. Still, there has to be more than salary and job opportunity to get physicians to relocate to rural locations. I myself would not want to live in any small town, regardless of region. Cities provide benefits in ways that only a concentrated areas of wealth can create.

And while I'm on the subject, Medicare contains two levels (Part A and Part B), hospital and medical coverage, which are strictly single-payer coverage in form. Yet, something else not well known is that Medicare prescription drug plans (Part D) are a partnership between government control and private insurance. If I need to be hospitalized or pay a physician for an out-patient service, the government manages it and funds my care. If, however, I need to pay for any one of the three medications that keep me functional, that responsibility is shared between private and public. I think you'll agree this isn't exactly socialized health care, at least not in the strict sense. It is more like a hybrid between the state and business.

Within the health care bill, there are undoubtedly other oversights in need of correction. In a time where Republicans and conservatives derisively refer to this legislation as Obamacare, I notably do not share their beliefs. Instead, I highlight an area in need of improvement, with the hope that others will point out similar limitations in the future. If The Patient Protection and Affordable Care Act were a software package, I'd want the next version to be even stronger. Unlike some, I wouldn't want to destroy it, line by line, bit by bit.

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