Critical Condition

NRO’s health-care blog.

More Medicare Patients Dropped


Yet more news, from the Columbus Dispatch, that Medicare patients are increasingly having difficulty gettting access to care. This blog has had a number of entries (latest one here) discussing the Mayo Clinic’s decision to drop patients in traditional Medicare from some of its primary-care practices.

At risk of patting myself on the back, this is what I anticipated in my recently published study of choices in Medicare. Basically, Medicare has three problems: A huge unfunded liability; ineffective reimbursements to providers (which are a result of centralized price-fixing by the government, which cause providers to shift costs to private payers); and lack of access.

The first two we’ve known about for some time. However, “unfunded liabilities” are not an issue folks discuss at the kitchen-table. The cost shift, which is actually a hidden tax that the government levies on the privately insured, is opaque enough that ordinary citizens are unable to discover it. The third problem hasn’t really been widespread enough to resonate.

Now it looks like it’s starting to have an impact at the kitchen-table: The Columbus Dispatch article actually features a patient, Janice Beaty, a 71-year old resident of Columbus, Ohio, whose gynecologist will no longer see her because he cannot run his practice on Medicare’s fees.

The only short-term solution to this is to allow Medicare Advantage programs, through which private insurers (which have demonstrated an ability to provide better co-ordinated care) offer Medicare benefits in competition against the government’s traditional Medicare monopoly. Medicare Advantage is not perfect (and my study proposes reforms). However, by giving Medicare dollars to private plans, which negotiate freely with providers, this alternative escapes the deadly consequences of price-fixing by central government.

The proposed “reform” attacks this choice in many ways: One is to levy a new tax on Medicare Advantage plans, as described by Sen. Robert Dole in today’s Wall Street Journal.

I believe that the increasingly apparent gap in access to care between Medicare beneficiaries and the privately insured (and even some cash-paying uninsured) explains one reason for the dizzying rush uphill to pass the proposed “reform,” which will cement the federal government’s role in determining when and whether each and every American may receive medical services.

If employer-based or individually purchased medical care remains partially free of federal control, the gap will become obvious to everyone within a few years, and the opportunity to impose government monopoly over our access to medical services will become politically impossible. On the other hand, by giving the U.S. Secretary of Health & Human Services full authority to decide what private health insurance covers, the proposed “reform” gives her the power to squeeze private insurance in order to demonstrate “equality of access” with current government plans.

The result? Thirty-year old women will have just as much difficulty finding a gynecologist as 71-year old Janice Beaty.

John R. Graham is director of Health Care Studies at the Pacific Research Institute.


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