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Naomi FreundlichAs Congress once again wrestles with “the doctor fix”—yet another postponement of the 21% cut in Medicare reimbursement that went into effect this month—the media has been swirling with stories warning of a mass exodus of doctors out of the federal program. The reason: In 2008 Medicare paid doctors 78% of what they get from private insurers; with the 21% cut they fear that their income will drop even lower.

The reports hit their peak late last week—USA Today wrote that “[t]he number of doctors refusing new Medicare patients because of low government payment rates is setting a new high,” while the American Medical Association announced that 31% of primary care doctors are restricting the number of Medicare patients they take. In a recent survey, the American Academy of Family Physicians found that 13% of respondents didn’t participate in Medicare last year, up from 8% in 2008 and 6% in 2004. Chic Older, executive director of the Arizona Medical Association told the Seattle Times ; “If the 21 percent cut goes into effect, we’re going to have a very severe problem in the state of Arizona.”

The question is: Will Medicare beneficiaries really face a shortage of providers and restrictions on their access to care? Or is this a scare tactic being used for political reasons?

First off, all this is happening against the backdrop of a major political fight in Congress over how much the government should invest in economic recovery. On Friday, the Senate passed a “doc fix” that would postpone the 21% cut in Medicare payments for another six months and provides a 2% increase in reimbursement instead. Unfortunately for doctors—and the seniors they count as patients—Nancy Pelosi has signaled that she may not be willing to settle for such a short-term solution. According to Politico, Pelosi was “caught off guard last week when Reid suddenly opted to pull the Medicare issue out of a jobs and economic relief bill on which the two leaders have been working for months.” For more background on the long history of the “sustainable growth rate” formula that mandates the Medicare cuts (enacted in 1997 by a Republican administration) and the unlikelihood of it ever being instituted long-term, see Maggie’s recent post here.

Still, the reality of the situation is that until the House votes to reverse the cut (which it will surely do), the Center for Medicare and Medicaid Services (CMS) must process claims with the 21% reduction. This has spooked doctors and given health care reform opponents a scare tactic to use in their campaign to paint the legislation as posing a serious risk to Medicare. Even though the SGR cuts have nothing to do with Medicare reform—which promises to increase payments to primary care doctors by 10% among other actions—the confusion has heightened the concern of providers.

The American Medical Association and some state-based medical societies have been warning of a growing boycott of Medicare by their members; releasing alarming statistics about doctors dropping out of Medicare or refusing to accept new patients who are covered under the program. They also warn of a huge onslaught of new Medicare enrollees as the more baby boomers become eligible for the program (something that won’t really peak  until 2020).

What is the real story here?

The Centers for Medicare and Medicaid Services says that 97% of doctors accept Medicare. The agency doesn’t know how many have refused to take new Medicare patients, Deputy Administrator Jonathan Blum told USA Today. “Medicare beneficiaries have good access to physician services. We do have concerns about access to primary care physicians.” This is not a new problem, but an ongoing workforce issue—the need to increase the number of primary care practitioners available, especially as 31 million more Americans obtain health care benefits under reform legislation, is pressing.

A survey released last September by the Center for Studying Health System Change found that 75 percent of physicians it surveyed accepted all or most new Medicare patients in 2008. In that same survey, some 87% of doctors said they were accepting most if not all new patients who were privately insured. And in its annual report to Congress in March, MedPac found that Medicare patients actually have an easier time finding doctors than their privately insured counterparts who are age 50 to 64. Only 6 percent of Medicare beneficiaries looked for a new primary-care physician in 2009. Within that group, just 12 percent said finding a doctor to treat them proved to be a big problem, the study found.

That compares with 8 percent of privately insured people ages 50 to 64 who looked for a new primary-care doctor last year, 21 percent of whom said finding one was a big problem. Clearly, the shortage of primary care physicians is has not reached a crisis point for Medicare recipients. (Those Americans covered under Medicaid, on the other hand, do have a serious problem accessing care: In the CSHSC survey, only 56% of physicians indicated that they were accepting most if not all new patients who had Medicaid; 28% reported accepting no new Medicaid patients.)

Kaiser Health News spoke with several doctors around the country about their frustration with the constant threat of the Medicare pay cut and in these vignettes you catch a more of the real story: Many physicians—especially those in primary care—are tired of worrying about the significant income loss they’ll face if the pay cuts go into effect. They are too busy with their practices to analyze the political posturing going on in Congress, and not yet convinced that the new health care legislation will lead to beneficial reforms and an increase in compensation from Medicare. In reality, leaving Medicare completely is not an option for most of these doctors, including those who work for hospitals and those like many cardiologists and geriatricians whose practices are predominantly made up of senior citizens. Also, once physicians choose to drop out of Medicare all together, they cannot submit any claims to the program for two years—even if payment policies change.

Still the panic and unease among many doctors remains palpable. In some cases they may be responding to urgent communications from their state medical societies about doctors leaving Medicare. For example, last month the Houston Chronicle reported; “Two years after a survey found nearly half of Texas doctors weren’t taking some new Medicare patients, new data shows 100 to 200 a year are now ending all involvement with the program. Before 2007, the number of doctors opting out averaged less than a handful a year.”

Dr. Susan Bailey, president of the Texas Medical Association told the Chronicle, “This new data shows the Medicare system is beginning to implode. If Congress doesn’t fix Medicare soon, there’ll be more and more doctors dropping out and Congress’ promise to provide medical care to seniors will be broken.”

The Texas Medical Association says that their survey also had these alarming findings: “In 2008, 42 percent of Texas doctors participating in the survey said they were no longer accepting all new Medicare patients. Among primary-care doctors, the percentage was 62 percent.”

Of course, the Texas Medical Association and its powerful political action arm (TexPac) broke ranks with the American Medical Association and opposed health care reform efforts throughout 2009. According to the Chronicle article, “TMA President Dr. William Fleming said ‘reform is doomed to failure’ without Medicare reform and called Congress’ failure to devise a rational payment plan ‘an insult to seniors, people with disabilities and military families.’”

It makes you wonder if the TMA’s reports of doctors boycotting Medicare are being used to sway public opinion on two distinct fronts. Like some fifty-one state medical societies who have signed a petition calling for Congress to abolish the SGR, the Texas chapter is lobbying to eliminate this balky and unworkable formula. But the group’s efforts may also be aimed at heightening opposition—especially among senior citizens—to health reform legislation in general.

After all, two hundred doctors opting out of Medicare in Texas is really just a drop in the bucket: There are nearly 60,000 non-federal physicians practicing in the state already. And according to the Wall Street Journal, in the first three years after Texas passed malpractice tort reform, some 7,000 new doctors “flocked” to the state—many of them practicing in obstetrics and primary care medicine.

In New York, the state medical society announced that about 1,100 doctors have left Medicare. As a matter of principle and to draw attention to the low reimbursement paid by Medicare, the president of the society announced that she will no longer take new Medicare patients. This also is little cause for alarm—there are over 88,000 total physicians practicing in New York State. And Leah McCormack, the president of the Medical Society of New York is a dermatologist in Forest Hills, Queens—a specialty practice where there are likely enough non-Medicare patients coming in to the office for cosmetic and other work to keep her practice profitable.

In the end, the battle over ending the SGR cuts to Medicare reimbursement is an emotional one for doctors. Even though primary care doctors earn an average of $186,044, many report that they struggle to keep their practices profitable and are forced to see more patients and reduce the time they spend with them. Much has been written about stemming the projected shortages in primary care; the need to better compensate such practitioners for preventive and other care; and fundamental changes that are needed in medical education. These are important issues that will be tackled as we begin to implement health reform over the next several years. The take-away message is that while the 21% cuts doctors are now facing are an administrative nightmare, they will be fleeting. And reports of a mass exodus by doctors from Medicare are overblown. Everyone agrees that Medicare needs an overhaul—but a misguided formula from a Republican Congress in 1997 will have no part in it.

Naomi Freundlich writes for the Century Foundation, where she works with THCB author Maggie Mahar on the HealthBeat project. Prior to joining the Century Foundation, she served as Science and Medicine Editor at Business Week from 1989 – 1997. Her work has appeared in numerous publications, including the New York Times, Business Week, Real Simple and Parents magazine.

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25 Responses for “Are Doctors Really Boycotting Medicare?”

  1. Of course the TMA is trying to “sway public opinion.” So what?
    When Sec. Sebelius sent out a piece of junk-mail to Medicare beneficiaries stating that their Medicare Advantage benefits won’t change, although the Chief Actuary of the Centers for Medicare & Medicaid Services forecasts that over 7 million seniors will lose Medicare Advantage, she’s trying to sway public opinion.
    Anyone who writes something for public consumption is trying to sway public opinion. The difference is that Sec. Sebelius used inaccurate statements but the TMA used a valid survey of its members.

  2. ExhaustedMD says:

    What is the real story here?
    Certainly not this one! You folks here at this blog can spin these statistics and agendas as much as you want, in the end, doctors resent being nickeled and dimed into financial ruin, and all you non clinicians who only resent that doctors can and should make a decent income after the work we put into it, BLLHHHH!!! The sound that comes from closed lips and the tongue sticking out!
    You morons see that doctors make $186K and think that is a net figure, we all drive Mercedes and live in $500K homes, and wear $2000 suits. Get a life, and come out of your cocoon of the alternate reality you want us all to accept is the only one! Again, beware of the person who resents being screwed, and moreso the one who does NOT care about being screwed and still works for pitiful wages.
    You think the adage “you get what you pay for” does not apply to health care providers!? Think about it, if you have the capacity to see a different point of view.

  3. Dan Urbach, MD says:

    I hope you’re right that there doctors will continue to accept Medicare patients. I doubt it. It is very easy to opt out of Medicare, in fact it is much easier than it is to stay in Medicare. Every month, it seems, there is a new reason to opt out. The recent, hopefully temporary, 21% cut is just one more.
    In my city, most primary care doctors are employed by hospital clinics. Those clinics generally accept new Medicare patients. But as the numbers of Medicare patients increase, the clinics will need to be subsidized more and more by their owner hospitals. Nowadays, hospitals are not run by doctors, rather by executives, who will decide whether to continue to accept Medicare patients based entirely on the bottom line. When the tax advantages of non-profit status are buried under losses from Medicaid and Medicare, access will be seriously threatened.
    That’s not to mention the loss of choice now faced by Medicare patients. They are forced to choose big clinics, whose doctors have 10-15 minutes to see them. That is inadequate, and patient care will certainly suffer as this situation grows ever worse.
    The numbers in this article may or may not be right, but they are cherry-picked to reflect the writer’s point of view. I believe they suggest a wildly optimistic view of the future, where doctors are just playing politics, and in reality they will go on seeing Medicare patients indefinitely. Sorry, but I just don’t see it happening.

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  5. I rely heavily on medicare because I have diabetes. I hope they don’t cut it anymore. I’ve been able to manage my diabetes quite well over the past 5 years. All of the gluten free foods that are out there now really help. There are so many resources to help people like us live a better life.
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  6. Gary Levin says:

    All of your comments seem to apply only to primary care doctors. You have left out the fact there are more specialists than GPs. Most serious problems or complicated cases, including elective surgeries are done by specialists, many of whom now are not taking either new patients or any at all. This will have severe impact upon patient accessiblity. Comments by ExhaustedMD (which is the common thread within doctor discussioins are true. He is being ‘polite’ about what most of us endure. Policy advocates and non clinicians, take your places at the back of the line.

  7. Gary Levin says:

    There are a lot of statistics given here. There is no mention of what the response rate was to the survey(s). These are notoriously low, often inaccurate and ususally from a biased response cohort. Most physicians do not respond to these surveys, because they are too busy and fed up with non clinicians doing surveys. Many do not belong to medical associations for many reasons, and would not respond since they are not on the mailing lists.

  8. alan lazaroff says:

    I am a geriatrician. You claim geriatricians have no ability to opt out of medicare. You are wrong; quite a few geriatricians have opted out. It is very very difficult for geriatricians to make a living in this country if they must rely upon the Medicare fee schedule.
    I am part of a 15 member geriatrics group. If there is a 21% cut in Medicare reimbursement, we are out of business.

  9. MD as HELL says:

    Yes

  10. FED UP DOC says:

    This is another insult to all Physicians taking care of Medicare (and worse, Medicaid) patients. It is somehow OK to give millions of dollars to health care and drug companies, but make physicians work for free. Most physicians are struggling to pay there overhead. Very few have much money left over to buy the second homes and Mercedes Benz the media wants consumers to concentrate on. Can you say the same of hospital administrators and insurance executives? Overhead is rising at alarming 20 to 30% each year. Reimbursement is declining every year. Adjusted for inflation, many Physicians are bringing in 50% of what they did 10 to 15 years ago with overhead increasing 100 to 200%. In addition, technology is driving up costs and this is not reflected in the reimbursement. How can you pay physicians the less than they were paid 10 to 15 years ago? Before they used a clipboard and a pen. Now we have servers, smartphones, EMR’s, IT staff or outsourcing and diagnostic equipment. I get paid $35 an eye for an OCT (scanning test of the retina and optic nerve). The unit costs $75,000 plus $3500 a year for a maintenance contract. this is only 1 of a half dozen pieces of equipment i must purchase and maintain. The result is that Physicians that are low tech and see high volume make money. YOU GET WHAT YOU PAY FOR. IT IS UNFAIR TO MEDICARE RECIPIENTS THAT HAVE PAID INTO THE SYSTEM THEIR WHOLE ADULT, WORKING LIFE to now have their access to care restricted. NAOMI FREUNDLICH, get a life (and a haircut) and stop fueling all this liberal crap. Access to healthcare to all is a right but making doctors work for FREE is NOT!!!!!!!

  11. JB McMunn, M.D. says:

    This article reflects a profound lack of understanding of the financial relationship between CMS and physicians. You can’t use “opt-out” numbers to track access to physicians. Very few opt out because it is a very radical step that severs pretty much all ties with Medicare.
    Opting out means that you can charge whatever you want, but Medicare will not pay for ANY of your bills. In other words, Medicare patients can only pay cash and will receive no help from CMS at all. Once you opt out, you have to wait a long time to get back in if you change your mind.
    On the other hand, a physician who doesn’t opt out is constrained by Medicare’s fee guidelines IF he or she sees Medicare patients but they are under NO obligation to see one single Medicare patient.
    Furthermore, some medical facilities require that you be on Medicare as a condition of having staff privileges.
    The easiest route for most of us is to simply remain on the list as active participants but restrict how many Medicare patients we will see. Some of my colleagues are accepting no new Medicare patients. Others have placed limits on new patients. This allows us to continue to accept Medicare patients on a case-by-case basis, or to keep current patients but decline new referrals.
    For example, during June while the 21% cut was in effect, I saw NO new Medicare referrals and I started warning my current patients that if the cuts persisted they would need to find another doctor. I will not see patients for 79% of the previous rates which, by the way, have not been significantly raised for a decade. We are paying 2010 expenses with 2001 fees.
    In summary, you can’t use opt-out numbers because they reflect only a very few physicians who have taken a radical step. However, since it is such a major decision, any increase in opt-outs is a serious cause for concern that there are major problems.
    A much better indicator would be to track how many practices are currently closed to Medicare or restricting new Medicare patients. This is much harder to track accurately, but rest assured it is definitely happening. It is also accelerating. June was the first time I refused to see new Medicare patients.

  12. old doc says:

    Old docs like me will”opt out” by retiring and a significant number of physicians are over 55. More and more younger doctors will end up being employees of hospitals and we will see more care provided by nurses and other extenders. Socialized medicine countries have survived without a collapse of physician involvement but there is more rationing and fewer treatment options.
    After the complete subjugation of medicine, perhaps we could expand government price-controls to the legal profession, entertainment,telecommunications, sports and Wall Street?

  13. JS Coleman says:

    Anesthesiologists only get 33% of what commercial insurances pay from Medicare. Try to live on that. We’d love to be treated like other physicians and be reimbursed at 78%, but CMS refuses to fix this. If more doctors would drop Medicare, we might have a chance to actually fix this problem instead of passing the buck. Go ahead and cut the physicians fees by 21%. What’s another 21% of nothing?

  14. ExhaustedMD says:

    Hey unbiased and objective readers, reading these above comments? This is the reality we as providers are living in, not the one these clueless and alternative agenda seekers that pervade these blog columns here are trying to fool you with!
    It is simple, allow the government to set the agenda for health care hereon, and you will get less than efficient health care. Because, as I say it again, beware not of the ones who are angry and outraged for being nickled and dimed into poverty and submission, but the ones who don’t care and provide care with no attention to reimbursement. Because the latter is either lying to you they don’t care, or, they are stupid for working for peanuts!!!
    And I look forward to the subsequent commenters who will again sell the lie that doctors deserve to be minimized. Not a socialist agenda, an antiphysician one! It seems to be more prevalent these days with the internet so pervasive in the culture!!!

  15. Joe Buckle says:

    ” Everyone agrees that Medicare needs an overhaul—but a misguided formula from a Republican Congress in 1997 will have no part in it.”
    Why didn’t the current Democrat president and democrat congress fix the issue with Healthcare reform? Hmmmm?
    Blaming the current situation in Medicare on a past Republican congress is like cursing in an argument. It’s the sign of a weak mind.

  16. James Durand says:

    Criminalization of our profession…that is the worse part of Medicare….Regulation up to the Wahoo…RAC.s racket terror documentation mandates, distracting coding (now a reason for a crime) , HIT, electronic surveillance, low payment …complex patients MEDICARE FACHISM..look doctors are slaves of third party payers and anyone who wants to victimize us. (government or corporate fascist tyranny over our profession is at its max.).
    let’s face it who wants to be a doctor in America??? You wouldn’t let your child spend his time and money to be a slave of insurance companies and bureaucracy.
    The insurance companies royalty and the government has destroyed free market in medicine . they have robbed the business between patients and doctors .
    Patients do not control cost fraud nor abuse (like they do in all other aspects off their lives). They are at the mercy and hostage to the bureaucracy of Medicare and insurance companies’ corporate royalty. Insurance Comp do not compete (as they do not give reimbursement for patient expenses and their clients do not see a difference of payment between a good or a bad doctor . INSURANCE COMPANIES HAVE ANTITRUST IMMUNITY AND WILL RAISE THE COST OF MEDICINE AS MUCH AS THEY WISH OWNING THE LINE IN HOSPITALS AND “PREFFERED” OBLOGATORY PHARMACIES.
    The situation with third party payment is a mess as no free market is present and doctors need freedom deregulation and have competition letting the patient judge is charges are in accordance to level of care.
    Reimbursement of patients expenses should be the rule for insurance companies to compete and let the patient decide who is a good and a bad doctor (they can decide what is a good house, car plumber and lawyer..But not a doctor?
    SIMPLIFY TO MAKE IT CHEAPER Stop documentation requirements coding LOSS OF TIME billing EXPENSES racs RACKET criminalization of medicine hit THAT WILL MAKE DOCTOR ORWELIAN SPIES
    We physicians need freedom, decriminalization of our profession and break the monopoly of third party payers .no more antitrust immunity for insurance companies that keep hostage the public with expensive hospitalizations and medications price control…STOP PRICE CONTROL..FREEDOM FOR THE PUBLIC AND LET PATIENTS IN MEDICARE BE ABLE TO PAY FOR THEIR CARE…IT SI A SHAME THAT MEDICARE PATIENTS HAVE LOST THEIR FREEDOM TO PAY FOR MEDICAL CARE…WHO MADE ILLEGAL FOR ELDERLY PATIENT TO BE ABLE TO PAY FOR MEDICAL CARE????

  17. old doc says:

    I am an anesthesiologist and yes Medicare allows about 33% of the average commercial payment rate for my specality. For Medicaid, it is 25% and continues to be reduced as well as CHIP. It is frustrating when Medicare patients stiff us on the 20% co-pay and caring for those wealthy seniors at welfare reimbursement rates who have net worths far greater than most doctors. There are just too many people on low pay, no pay government insurance. Welfare is rampant – the disabled, self-inflicted diseased people under 65, the healthy young on Medicaid now being expanded by the feds and the states. Too many people have no committment or participation to the well-being and prosperity of this country. Unfortunately physicians are “taxed” twice – first as regular taxpayers and second by getting paid far below the customary rate. As long as we continue to keep accepting decreasing pay we will get what we deserve.

  18. George A. Brooks MD says:

    I apologize for the length-got carried away.But, I hope I have been a voice for many and informative to all.
    Althought the article in point tries to take a balanced view, clearly there is an attempt to make a case that the number of dissenting doctors and their dissenting organizations are politically motivated and seeking only to preserve the income status of doctors. The truth is that many, many doctors not making the statistics quoted have been preparing alternate sources of income since 2007 and within 5 years will be independent of the govt plans. I am among those doctors in private family practice with such a plan. Medicare is 20% of my gross income and maybe 5% of my after tax income. The only reason I am still taking Medicare is to preserve the jobs of my faithful employees.
    OK, so I am a nice guy. But, as soon as my other business plans have reached critical mass (maybe 2-3 more years), I am gone ! I quit Medicaid a long time ago because payment 20% less than Medicare was not ecomomically viable. If they cut Medicare by 21% (as threatened) at a time when the cost of doing business has risen by about 20% over the last decade of Medicare failing to give pay increases, then I will have to quit Medicare sooner than expected and dismiss 2-3 of my employees.
    In any case, I will quit taking new Medicare patients in 1-1 1/2 years, if plans go well. I will also start recommemding those Medicare patients requiring the most time for complicated care to other doctors to lighten my load. Those things do not show up in the statistics. The writer did a lot of bookwork, but clearly did not talk to any of the doctors in the trenches. And, the issue of older doctors cutting back on their practices, doctors retiring or dying and not being replaced by doctors coming out of medical school has not been addressed.
    Further, it would be interesting to know how many doctors educated in foreign countries are being recruited by the govt and put on the fast track to come here in view of the looming shortage of primary care doctors.
    It does not require one to look far before finding much compelling data on the impending disastrous shortage of primary care doctors. The plan to deal with this (starting 5-10 years from now) includes govt run clnics staffed by nurse practitioners (RN’s with 2 years of additonal training to replace the doctor who takes 8 years to train) and supervised by doctors recruited form foriegn countries as a condition of their visa and doctors whose cost for medical school was paid by the govt for a commitment to do such work for awhile.
    The response by doctors (I predict between 5-10 years from now and include me) will be to offer Medicare patients an alternative means for health care provided by a doctor to those who join the doctor’s membership practice, let’s say for a $1,500 -$2,000 annual fee.
    For those who scoff, this boutique medicine is happening now already in the Houston area and is gaining popularity. Do the math: only 500 patients in practice (maybe seeing 10/day leisurly)x $1,500 = $750,000/year in membership fees before billing insurance. Let’s say you only had 200 patients and saw 4 daily and had two employees. Do the math…do you seriously think we are not headed this way? LOL !
    Of course, Congress could forbid it, which is why I have plan A above. But, no matter what the law and no matter what this bunch of incompetent losers tries to do to control the doctors and force them to wages making it not worth the 12 years of advanced education we now undertake to prepare ourselves for this most noble of all professions, already a service to mankind more than a profit driven trade, they will not be able to stifle the creativity of the mind when driven by necessity.
    I apologize again to those who enduredd to the end for the length.

  19. ExhaustedMD says:

    Nah, Dr Brooks, spells it out fine to me! This site is becoming so lame due to a bunch of non providers trying to sell the lie that Obamacare will improve health care.
    And then there are the repeat commenters who obviously are equally in the back pocket of Democraps, or terminally optimistic that “things will work out”, not realizing the creators of this garbage legislation have no clue what are the “things” that need worked out before putting the legislation into motion!
    So, let’s hope the voters who are paying attention outnumber the frauds and failures in November.
    I’m not a Republican, but be sure I will NOT be voting for any Democrap in my state come November!

  20. ExhaustedMD says:

    Just saw at Yahoo news something to perk up all those supporters of government employed doctors: Ah-nold S just got the court to approve his minimum wage edict, and it notes in the end of the article that “doctors and lawyers who work for the state will NOT be paid at all until the budget is passed”, so, they will not even get minimum wage, which is an insult anyway, but NOTHING!
    Colleagues, we all know California and Massachusetts are the trend setters for this country. Are you ready to see no pay if and moreso when the feds are in such dire straits, they will see not paying doctors as a budget cutter?! And all you anti-physician commenters here, what if you wind up needing to go to a state/government facility for care and can’t get it if the doctor ain’t paid?
    Don’t see this stuff, do you, dissenters!?!?!?!?!?!?!?!?

  21. Robert W. Sugerman, M.D. says:

    Medical colleagues and all others:
    The demise of Medicare was first predicted years before some of us (including myself) entered the profession. I agree that Ms. Freundlich’s statistics and views grossly underestimate the crisis we are facing.
    Now that implosion of the system appears to be drawing near, it is important that we all keep cool heads in our discussions. Political sniping serves no purpose in resolving critical issues of national importance. In the end, we are all in this mess together.
    I sincerely believe that a permanent solution to Medicare funding will come neither from legislative bodies nor from physicians’ organizations, but from a growing number of aging baby boomers who will come to their senses and form a national grassroots campaign. Some degree of belt tightening will be required of all stakeholders, including patients who have already paid into the system and current taxpayers who continue to fund it.
    Going forward, there will be no room in Medicare’s budget for fraud and abuse (those few bad apples among us caused our profession to become demonized and overregulated in the first place), nor for additional administrative burdens to physicians. Until the issues of Medicare funding and physician autonomy are reconciled, I will remain quietly on the sidelines among the growing ranks of our profession who have not “opted out” but have significantly limited their participation in the program.
    All in all, the current state of affairs makes me very sad, although I remain hopeful that we have enough collective wisdom, compassion and will as a country to create a sustainable program that will meet the needs of a vulnerable population.

  22. ExhaustedMD says:

    With all due respect to Dr Sugerman, this issue is political because the Democrats made it an issue, as they made no real sincere effort to responsibly engage the Republicans, not that the other party would have had much of substance to offer in the end.
    I would be attacking the republicans if this was their doing, so it is not about one party, but the system out of control and no real respect or concern for implementing real reforms and changes of true impact.
    And this site is basically aiding and abetting the process. Eventually, I will stop attending this site when it is hopeless irrelevant to unbiased and objective dialogue by all interacting parties. At least I read some colleagues are speaking out still for now. Did you read how there is now an internet site being set up to allegedly guide the public? Guide it to what is the real question!

    • Dan c says:

      Karl, Karl Rove, is that you. Please, don’t go away mad, just go away. You are nothing more then a political hack. exhausedmd, yeah right. You are nothing more then a paid blogger schlepping for a nickle a post.

      • DeterminedMD says:

        Get a life and read 2012 posts, I gave up this alias over 18 months ago and have been basically censored by this fraud blog site anyway for their one sided agenda, ie yours!

  23. Nobody says:

    Has there been any attemtps to unionize nationally with other physicians. Collective bargaining seems to be working against us, but yet as smart as we think we are as doctors, there doesn’t seem to be a push to organize.

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