How Obamacare hurts seniors
My patient George is now 80 years old and has been coming to see me since he was 65. He brings his pill bottles to each visit; over the years, the number of bottles and pills has increased.
Medicare has served him well over these 15 years, from the time an ultrasound ordered in the emergency room by a physician’s assistant missed a bursting appendix but a CT scan found it before it was too late (Medicare paid for both tests), to the time when his lymphoma was cured with the help of a costly new targeted therapy.
His hernia was repaired through a scope using the latest expensive metal mesh, and when he could no longer walk without assistance, Medicare paid for his walking cane. At 80, he is alert and full of life, telling me a new joke whenever he comes in.
What will the future of Medicare look like for patients like George? Will I still be able to order the best care for his hernia, his cancer or his addled gait? Will I have to fight for every drug approval?
I am concerned that as Obamacare attempts to cut $716 billion from Medicare, the belt-tightening orchestrated by the Independent Payment Advisory Board will have a trickle-down effect on my practice.
The 15 appointed members of this board will not include practicing physicians, and I am worried that it will not only cut my fees to an unworkably low level but also base its rulings on findings that claim one treatment is better than another yet ignore the art of medicine.
Ours is a field where an ultrasound can miss something that a CT scan ultimately finds, where a physician’s assistant doesn’t have the same training as a seasoned physician, where a ruling that limits the number of tests I can order could harm an elderly but active patient like George.
The advantage of Medicare for practicing doctors like me has always been that we can order the tests and treatments we need without excessive restrictions or denials.
This may seem like a waste of the government’s money, but it is the only way we are able to work with an insurance program that covers patients with more medical problems because of their age, yet pays us less to see them than we are paid with private insurance that covers younger patients with fewer problems.
No wonder a recent Doctor Patient Medical Association poll found that 74% of doctors say they will stop accepting Medicare patients or will leave Medicare entirely because of Obamacare.
I believe Rep. Paul Ryan’s proposal to save Medicare dollars by raising the eligibility age to 67 is a step in the right direction toward saving the entire program.
Back when George was 65, we didn’t have the same preventive treatments available, and people weren’t as well informed about the positive benefits of diet and exercise. Today’s 65-year-old is in much better shape, generally, than George was.
The Ryan plan — which could potentially become the law of the land if Mitt Romney becomes President — makes far more sense for George and the rest of my patients than the excessive restrictions coming from Washington under Obamacare.
The Romney/Ryan plan would keep traditional fee-for-service Medicare as an option while also allowing seniors to use the money to buy private insurance.
This insurance must provide comparable coverage if patients like George select that option.
Private insurance provided to elderly workers or Medicare Advantage are becoming easier for doctors like me to work with than traditional Medicare, which is al- ready becoming more restrictive.
The Romney/Ryan plan will provide lower-income seniors like George with more support while allowing richer patients the option of paying out of pocket for more expensive plans. What’s not to like about that? Recently, my father-in-law, 85, had an extensive bladder cancer robotically removed through a minimal incision; at the same time, my own father needed two visits to different urologists before he knew for sure that his bladder had dropped into a hernia.
I have a sinking feeling that neither my father’s workup nor my father-in-law’s operation would be approved by Obamacare’s board.
But, in a crucial distinction, they would be covered under the kind of private insurance that the Romney/Ryan plan would allow senior citizens to buy.
Medicare as we know it is more likely to survive by adding options, not by taking them away.
New health law will cut $716 billion from Medicare while giving doctors fewer options