The Supreme Court just heard arguments over the constitutionality of the Affordable Care Act, aka Obamacare. At issue is the constitutionality of mandates that require folks to purchase health insurance.
Mandates were originally a Republican idea designed to guarantee private insurance companies a continuing roll in healthcare. The alternatives are an employer-based system that leaves an ever-growing number of us without coverage (i.e. the status quo) or a universal government system without private insurance companies.
For years, insurers have been channeling most of us into HMOs that offer less and less care for more and more money. Come on, admit it. Like Peter Finch, most of you were thinking, “I’m mad as hell, and I’m not going to take this anymore!”
You might also think Republicans would be leading the charge to validate mandates and save private insurers a place at the table. But the fear mongers are spreading mischief. Republicans have put a finger in the wind, and their drill sergeants are barking, “To the rear, MARCH!”
Ironically, I’ve discovered some of the most fearful about healthcare are geezers like me who are already in a government system, Medicare. My wife and I recently had three other geezer couples over for dinner, and the conversation turned to Obamacare. Turns out there is a rumor going around that, because of Obamacare, doctors are no longer accepting Medicare patients.
Like any juicy rumor, there’s a germ of truth in it. Medicare reimburses doctors at lower rates and there is paperwork involved, so some doctors opt out. However, this was going on well before Obamacare. The National Center for Health Statistics (part of the CDC) has been reporting on it at least since the Bush Administration. There’s a lag in the data, but they found about 10 percent of doctors were not accepting Medicare patients.
Some of these are doctors with full caseloads, so they’re not accepting any new patients. Other doctors treat geezer diseases and they’d be out of business if they didn’t take Medicare. The latest fad for them is “concierge” medicine, where doctors try to get around low reimbursement rates (both Medicare and HMO) and squeeze a premium out of us geezers for speedy access.
Bear in mind that Obamacare really doesn’t kick in until 2014. If the Supreme Court doesn’t screw things up, doctors could look on the bright side and say “Wow, there are millions of new customers out there for me.”
One thing we can say for sure is that the game of brinkmanship Republicans play over the debt ceiling feeds the rumors. It doesn’t make financial sense, but the Medicare budget and reimbursement rates have become linked to this all-too-frequent game of chicken. Doctors don’t like uncertainty, and that has become an issue for them. So if more doctors are turning away Medicare patients, the real reason might be the debt-ceiling politics and not Obamacare.