Tuesday, May 12, 2009

Health Care Reform

I am back after having been gone to Dekalb, Illinois to see my oldest daughter graduate with her Master's degree in philosophy. It was a very fun trip and I enjoy spending time with her.

I want to talk a little bit about health care reform as that is currently being considered by the US Senate and the Obama administration. I will outline the various options that are being considered but today I just want to look at one of them, the idea of making a Medicare like program to all Americans. My views are my own and do not reflect the views of Cottonwood. This is my personal opinion.

Medicare has been a program that provides insurance coverage by the Federal government for all adults 65 or older. In many ways it as been a successful program but it is in financial difficulty now and there are proposed payment rate reductions to both health care providers and hospitals.

One problem I have had with the program all along is the lack of choice available to seniors. A person age 65 or older does not have to use Medicare. However if a patient wishes to go to a physician and pay out of pocket he or she is prevented from doing so as the doctor is not permitted to charge the patient outside the Medicare program if he or she sees any Medicare patients at all. So while I had my office practice no patient for confidentiality purposes could pay out of pocket or I would have run afoul of federal regulations with severe penalties. I had to bill Medicare. That is just not right. For psychiatric patients the reimbursement was only 50 % of the Medicare charge. I did see a number of geriatric patients but each one was a financial loss. If a Medicare like program was available to all Americans I do not see how a psychiatrist could maintain a private practice. Hospitals cannot survive on Medicare payments as well.

Another problem with this approach to health care reform is that because of lower government set rates the private insurers will be gradually driven out of business and the Medicare like program would then be the only insurer, restricting both patient choice and and resulting in restriction of services.

I hope that this approach to health care reform is not adopted.

Thought for the day

One size does not fit all.

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