R.J. Weiss made his hosting debut today with the 189th Cavalcade of Risk – be sure to check it out. This article from David Williams gets my vote as one of the most interesting in this edition of the Cavalcade. David writes about a small but growing number of doctors who are choosing to not accept Medicare patients thanks to ever-increasing regulations and paperwork, along with reimbursement that’s lower than the doctors can get elsewhere.
Although this may be cause for alarm, David points out the silver linings and reminds us that our current model of relying on insurance for all healthcare services (as opposed to just major expenses) might be doing more harm than good. Getting away form this system for routine primary care could make the whole process more efficient, less expensive for the patient, and result in less paperwork for doctors.
But of course there are problems with this too. Medicare mostly covers retirees, many of whom are on a fixed income and rely on Medicare for medical bills. Even routine primary care might be beyond the scope of their budgets if routine care coverage under Medicare weren’t available, or if a significant number of doctors stopped accepting Medicare. Transitioning to a system in which people pay for their own routine medical care would probably have to be done gradually, with a lot of education and planning assistance along the way. It might work for the next generation of seniors, but those who have already finished their working careers probably need to continue to be able to depend on Medicare and Medigap policies to cover all or nearly all of their medical costs.
David also questions why we have such varied rates for the same medical procedure, done by the same doctors, depending on whose paying. And he also brings up the fact that primary care docs make so much less than specialists. Two very good points, and not necessarily things that we need to continue to keep in place. It would certainly be easier to maintain transparency if costs were level regardless of who was paying. And evening out the reimbursement rates among specialists and primary care docs would probably go a long way towards fixing the shortage of primary care physicians in this country.