In the wake of mounting payment delays and shrinking reimbursements, more and more physicians are turning away Medicare patients.  One recent study shows nearly 30 percent of Medicare beneficiaries seeking a primary care doctor had trouble finding one.  Another study demonstrates that less than 40 percent of primary care doctors in states like Texas and New York are accepting new Medicare patients.

 One primary care doctor explains the problem this way: 

Contrary to popular belief, Medicare’s paperwork requirements and pre-authorization obstacles are just [as] onerous as those of private insurers. Combined with the continuing threat of downward physician reimbursements, and the baseline complexity of a typical Medicare patient, it is no wonder that doctors are dropping Medicare in droves. 

My own family doctor reports that Medicare is poorly managed, inefficient and monopolistic.  Payment delays of up to nine months on significant sums are not uncommon.  For those doctors owed reimbursement for services rendered, there is no recourse or allowance for the delays, which can freeze a small office’s cash flow, adversely impacting staff salaries and putting a squeeze on vital overhead items like rent and malpractice insurance.  Of course, their own salaries are also negatively impacted.  Communications with Medicare administrators are mostly non-existent.  When contacted about individual cases, these administrators mostly cannot address simple, specific questions or provide any information even after multiple contacts and seemingly interminable delays of 30 minutes or more while waiting in a telephone queue.  Most doctors would prefer to spend their time serving their patient population, and find it increasingly necessary to jettison the red tape for more rational reimbursement plans.

 Not surprisingly, acceptance rates for Medicaid patients are similar to those for Medicare.  A 2005 survey showed that only 50 percent of physicians accept this insurance.  Private insurance plans may also present problems.  Even large HMOs like Aetna or Blue Cross are increasingly dropped by physicians.  Why?  Most of these plans key their reimbursements to Medicare/Medicaid repayment schedules.

 In some other cases, where doctors receive lower reimbursement from government or private insurers, patients are expected to pay more of the bill.  As you might imagine, that approach is not always so popular with patients.  Many such patients have come to expect that benefits are intended to fully cover each contingency and every cost associated with their individual case.  The tension feeds a growing perception that individual health care expenses are no longer each patient’s personal responsibility.

 Nonetheless, many patients might otherwise avoid the health care bureaucracy altogether and opt to pay their own medical bills rather than rely upon government-sponsored benefits.  There is only one problem:  you could be denied Social Security benefits for which you have spent a lifetime paying taxes.

 So where might this all lead us?  If universal health care coverage ever becomes law—especially if such a plan includes a public component—the government programs that doctors and some patients are already rejecting in droves will likely become the model for single-payer managed health care.  This is why some authorities have concluded that, “[w]e already know what government-run health care looks like.”  This is not good for doctors or their patients.