You Have a Voice in Whether You Can See Your Doctor

September 17, 2007

America’s health care system is ailing. We can see the symptoms everywhere.

The cost of health insurance has grown by 87 percent in the past six years, pushing employers to drop health benefits for their workers and pushing the number of uninsured Americans to 47 million, including 18 million who earn more than $50,000 a year. In the meantime, physicians struggle to keep their doors open as payment for their services falls behind the cost of doing business.

And that could make all of us sick. Why? Because at the heart of these issues is an urgent question: will you have a doctor when you need one – regardless of how good your insurance is?  The answer comes from an unexpected source: Medicare. Whether you have Medicare coverage or not, the system’s payment to doctors can determine whether you – as an insured employee or a self-insured entrepreneur – will be able to see your doctor. Insurance companies pattern their physician payment after Medicare.

Since 2003, the federal formula has required that Medicare pay less for the care that elderly and disabled patients receive from their doctors. In some years, that reduction has been as much as 7 percent. Next year, Medicare plans to cut 10 percent from what your doctor earns for caring for elderly and disabled patients. The year after that, there is another reduction of at least 5 percent scheduled to become effective.

In past years, Congress has intervened, but usually to keep payments only at the previous year’s level. Sounds good, but businesses that fail to increase revenues cannot keep up with inflation and must either cut their costs or close their doors. For doctors, cutting costs can mean limiting the number of Medicare patients -- whose Medicare benefits pay less than the cost of providing the service.

Certainly, your doctor’s plight may seem of little concern to you. But the Medicare payment – and the private insurance company policies that base their payment on what Medicare pays – directly affects whether your doctor stays in business.

That’s a problem for Minnesota, where 578,171 uninsured and insured people are among the 56 million Americans who are medically disenfranchised – defined as people who live in areas with too few primary care physicians to provide primary and preventive care, and likely have limited access to health care. The challenge may only get worse with time, as Baby Boomers age, develop medical conditions that accompany aging and require more frequent and comprehensive health care.

You hold the answer. Right now, the U.S. Senate is debating continuation of the State Children’s Health Insurance Program.  This is the vehicle that, with enough support from you, also can contain a provision that would prevent Medicare – and the insurance companies that follow its lead – from slashing your doctor’s payment by 10 percent. All that’s needed is a phone call or an e-mail to Sens. Norm Coleman and Amy Klobuchar. Tell them to prevent the pending 15-percent cuts in Medicare payments to physicians.

Lynne Lillie, M.D., FAAFP, President
Minnesota Academy of Family Physicians

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