We are not, as advertised, at a crossroads in American Healthcare; we are at a T-junction. Should we continue on our current path, that is straight ahead, we will crash through a fiscal barrier and learn that you can’t defy the law of financial gravity, if you’ll pardon the pun. If we move to the right, then the role of government will be as limited as possible while still remaining humane. If we figuratively go to left, then the role of government will likely be as great as possible. Either way we go, left or right, the necessary cuts to those things that have been heretofore medically available to us, and I am specifically speaking about the ability to see a real doctor, will change the way each and every one of us thinks about our own healthcare and the decisions we will each face and make, will determine if and when the doctor is in for you.
Where to begin regarding cuts? The Community Living Assistance Services and Supports (CLASS) Act comes readily to mind. This program, providing long term care for the elderly, came under the ax the other week, as it was fiscally unsustainable, even by today’s standards. Next, in today’s MacPaper, USA Today, there is a report of more states limiting Medicaid hospital stays to as few as ten per year. Then there’s the Independent Panel Advisory Board (IPAB), a 15 member independent panel, to be appointed by the president and confirmed by the Senate. This panel will be charged with enforcing a cap on Medicare; that right folks, a cap on the Mother of all entitlement programs. By 2018 this limit is permanently set at per capita gross domestic product growth plus one percent.
But the unkindest cut of all, for you, the patient, will be the long-delayed 29% cut in Medicare payments to physicians starting on January 1, 2012. Not only will Medicare and Medicaid payments be reduced, but all commercial insurance contracts with doctors that rely on Medicare fees as a base will also be cut. The effect of this reduction on your doctor’s remuneration will be profound and likely kindle not only a sizable percentage of physicians no longer accepting Medicare patients, but will also engender many physician’s to throw in the towel, and terminate their medical practices, thus adding to the already substantive physician shortage.
So what will be the result of all this? A two-tiered system of healthcare with significantly limited services and benefits, whereby some physicians accept no insurance of any sort with the patient paying for his or her services, or as an alternative tier, the probable majority of physicians accepting what the current law will eventually create; a single payer Federal system.
What decision do you think the better physicians will make? Will the doctor be in for you? Is it worth your while to pay for the services of a physician as opposed to an extender? Should you put aside funds in an HSA to save against the proverbial rainy day? These are just a smattering of the questions that you will have to answer should you wish to access the better care tier, not wait in long lines for months to be seen and hoping that you will see a real doctor, and availing yourself of the latest medical technology and treatment.
The patient-consumer now must ask himself what is the value of his or her health and ability to provide for the family? For what and for how much will he or she insure against injury, long-term illness or a medical disaster? What is the value to you and your family of a doctor’s cognitive ability and judgment or the price of his or her hand to eye coordination in the operating room?
Right now in some instances it is less than that of a plumber coming to your house at night for an emergency. Right now, it is a near money-losing situation to see a Medicare patient, let alone one who has Medicaid. When the reduction goes into effect, your doctor will actually pay more to see the average Medicare patient than she can collect. Would you sell a product for less than it’s worth? Would you allow your business to continually take a loss? Why does this situation apply to your doctor?
On our radio program of October 23, 2011, my guest was Dr. Robert Farkas, a highly respected nephrologist and true patient advocate in the Dallas community. During the course of the discussion, towards the end of the program, Dr. Farkas spoke of his dog’s illness and the fact that though the dog was likely going to die, Bob spent $10,000 attempting to save his dog…. a dog mind you. This scenario screams the simple message- if you are willing to sacrifice a substantive amount of capital on your best four legged friend, what will you spend on a child, or a wife or a loved one should you have the means? Why should a skilled physician not avail themselves of the same opportunities to pursue happiness that you have? What is the difference between the cost of something and its value to you?
These are questions all of us must answer for ourselves. The Government, despite its claims, just can’t afford healthcare anymore, for we will either sink or swim with it. Should we swim, we must find different strokes for different folks and realize and accept the unfairness of life while remaining true to our own humanity and our heritage of being a charitable people. The difference now is that the charity will have to come from us and not Washington. The difference is now we must first place a value on our own healthcare and that of our loved ones. Will the doctor be in for you?