The New York Times’ story by Reed Abelson, quoted below, describes Medicare’s track record, pro and con, since it was established in the 1960s, because it may be the model for any public plan option under anticipated health reform legislation.

First, some background.

It is important to note that in the 2008 Medicare Payment Advisory Commission Report, the commissioners did not report Medicare patients as having difficulty finding physicians. (The methodology for calculating access to care is shown in a chart in its report.)  Therefore, the issue of doctor participation in Medicare, at least in the eyes of policy makers, likely will be assessed using the  their own statistics rather than medical manpower projections, specialty-specific statistics and other sources providing data about Medicare patients access to care, which, in general, do  not tend to agree with the commission’s data.

What could this mean to you?

On April 1, 2009, the Times had story about the challenges of finding a doctor who takes Medicare.

“Two trends are converging: there is a shortage of internists nationally — the American College of Physicians, the organization for internists, estimates that by 2025 there will be 35,000 to 45,000 fewer than the population needs — and internists are increasingly unwilling to accept new Medicare patients. (Emphasis added)

…”Many people, just as they become eligible for Medicare, discover that the insurance rug has been pulled out from under them. Some doctors — often internists but also gastroenterologists, gynecologists, psychiatrists and other specialists — are no longer accepting Medicare, either because they have opted out of the insurance system or they are not accepting new patients with Medicare coverage. The doctors’ reasons: reimbursement rates are too low and paperwork too much of a hassle. (Emphasis added)

As the debate about health reform continues,  these two trends need to be understood to get a workable solution.

Depending on which sources you find most credible, either there is not a problem with Medicare patient access to physicians or doctors are going missing from Medicare today.

In any case, the debate about a public plan as part of a health care reform bill will center on Medicare as a model.  Please pay attention.

New York Times

“Should the government get in the health insurance business?

“The question will be debated fiercely in coming months as President Obama and some Democratic lawmakers push for the creation of a government-run plan to compete with private insurance companies for the business of nearly 50 million people who are without insurance.

“Insurers say they fear they will be driven out of the business, unable to compete with the government’s market power to demand lower prices. Other critics warn of another unwieldy federal bureaucracy subject to the whims of Congress. But supporters say private insurers have failed to offer affordable coverage to all Americans and that the government needs to step up.

“It won’t be the first time. The federal government is already in the health insurance business in a big way, providing coverage to more than 45 million elderly and disabled people through Medicare. (Another government plan, Medicaid, is run and financed in combination with the states to provide health care to about 60 million poor people.)

“How closely a new public plan would resemble Medicare is unclear. Still, Medicare’s record offers insights into the benefits and pitfalls of public health care. While it has driven down costs though its sheer market dominance, Medicare has also been extremely slow in using its power to encourage or compel more effective health care. And, of course, providing health care for older Americans has been expensive. Medicare is expected to represent an estimated 13 percent of next year’s federal budget.”

Source: New York Times, July 5, 2009

Source: New York Times, April 1, 2009

Source: 2008 Medicare Payment Advisory Committee Report