I have made the heart-wrenching decision as a physician to opt out of Medicare. I do so after working with Sen. Stevens, Sen. Murkowski and Rep. Young for a decade in hopes we could ensure seniors would be able to continue to receive medical services in Alaska.
On a visit costing $115, Medicare pays $40, secondary insurance pays $7, and the rest -- $68 -- is a loss, not a tax write- off. It takes six insurance paying patient visits to offset losses from one Medicare or Medicaid patient.
The House health care bills, HR3590/HR3962, increase the number of people not paying their share of the costs and will lead doctors to opt out of Medicare or retire early.
Anchorage has 75 family physicians, down from 180. Physician shortages like these are caused by government interference in the free market. Government artificially keeps reimbursement rates low, forcing other patients, and insurance companies, to pick up the additional costs. Family practice residencies are filled with foreign medical graduates because of high costs (more than $200,000) associated with medical school. Low physician reimbursement rates make it difficult to repay loans.
Medicare and Medicaid auditors are paid on commission, can fine us $2,000 to $50,000 for one charting mistake or billing error, and then extrapolate this over the practice and drive us out of business ... all for one minor mistake. There is fraud, but this system that penalizes us severely for simple errors is untenable.
In these bills malpractice reform is restricted, health savings accounts (which help reduce costs and fraud) are essentially eliminated, and taxes and fees on insurance and medical services are increased. There are no Medicare/Medicaid rate, rule, or audit reforms, or tax write-offs for business losses.
One section in Sen. Harry Reid's bill says Medicare will no longer pay for home health services, durable medical goods, and possibly labs, X-rays, prescriptions or other services written by providers who have opted out of Medicare. Many talented physicians have had to opt out of Medicare (and by this law must opt out of Medicaid and the military's Tricare also) to stay in business. People will no longer be able to see these physicians because of government financial restrictions or will be forced to pay all medical bills associated with these visits themselves.
Bills under consideration cut Medicare spending by $460 billion, raise fees on medical services, increase physicians' administrative burdens, promote electronic medical records with mandated reporting of outcomes data, and increase business costs so it will be impossible for small practices to survive.
My decision to withdraw from Medicare was also precipitated by U.S. Preventive Services Task Force's recommendation that breast cancer screening mammograms should only be done on women between age 50 and 74. Approximately 48 percent of my patients with breast cancer developed it before age 50. Up to 1.2 percent of my practice, mostly young mothers, could have died if this were a national guideline.
The Senate bill has this task force and other committees determining what tests will be covered for patients. I am concerned that penalties may be imposed on insurance companies, and maybe providers, for going against these guidelines. The Hippocratic Oath compels us to protect the health of all humans throughout life, and many provisions in these health care bills would cause us to violate that oath.
Physicians and patients (not government) should decide the best, most cost- effective medical treatment for patients. Government should not dictate to insurance companies or providers which tests can or cannot be covered. Medicine is changing too rapidly for guidelines to be made at a national level.
I have worked in government medical facilities and in private practice for the last 26 years. Physicians provide timelier, less costly and more patient-oriented care if not overseen by hordes of non-producing government administrators.
I am in favor of reform, but current bills before Congress will collapse our health care system and work against the freedoms we are guaranteed under the Constitution. Government should not be allowed to force people to purchase health insurance, mandate what health care services you are allowed, or increase our taxes astronomically to support a huge government health care bureaucracy that will bankrupt us as individuals and as a nation.
Ilona Farr, M.D., is a physician in Anchorage.
By ILONA FARR, M.D.