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Sep 24, 2009 10:00 pm US/Central
The High Cost Of Medicare Surprising To Seniors
ROCKWALL (CBS 11 / TXA 21) ―
There's only one way to say it. Medicare is cheap. The government doesn't pay a lot to reimburse doctors and doctors don't have to take Medicare patients. So why are you paying all that money into Medicare? That's what a Rockwall man wants to know.
Retirement was supposed to be worry free for John Spinelli. When Spinelli needed a physical, he whipped out his trusty Medicare card, thinking coverage was going to be good. "That's not what I thought that is what they said," according to Spinelli.
Spinelli is referring to the federal government. Before Spinelli retired, he had private insurance. Now, he uses Medicare, the government healthcare system that millions of Americans paid into for years. But some doctor offices aren't very helpful when you call to make an appointment. "There's always a hesitation - a tonality change - that is when they go from talking to you - to talking at you," said Spinelli. He went to the government's website to make an appointment for a checkup. He found 4 different doctors and got 4 answers.
Spinelli says once he told a receptionist that he was on Medicare, and the phone went silent. The receptionist told him the doctor was not taking new patients.
In June the Medicare Payment Advisory Commission issued a report, stating it "Is concerned about the continuing trend of greater access problems for primary care." That trend has risen 38 percent in 4 years, with patients classifying it as a "big problem."
The Texas Medical Association [TMA], which represents doctors, states the government, has known about this problem for years. The former president of the TMA, Dr. Bohn Allen, said "Medicare payments are artificially low due to laws that limit payments." The TMA's data shows Medicare undervalues costs in the areas of family medicine, pediatrics and multispecialty practices. Mr. Allen also said "Medicare pays less than the physician cost and pays less than the hospital cost because medical inflation has continued to rise but held prices at the same level."
The Centers for Medicare and Medicaid in Washington determines the fees for reimbursement according to the law. But ultimately, it works like a see-saw. If the agency raises the payments for a cardiologist, it has to lower the fees for someone else. The law requires the budget to have no surplus and no deficit, otherwise known as budget neutral. In the end, someone will always get short-changed.
CBS11 examined some common medical needs and procedures focusing on the difference between what Medicare pays and what private insurance pays. For a comprehensive medical exam, like the one Mr. Spinelli wanted, Medicare pays doctors 34 percent less than private insurance. For a hernia operation, Medicare pays 15 percent less, and for an eye exam, Medicare pays 16 percent less. And unless Congress takes action this year, Medicare reimbursement rates will go even lower. Sources tell CBS11 to expect a cut of 21.5% or more in 2010.
Senator Kay Bailey Hutchinson says the fault lies with the government workers who run Medicare, but congress is trying to fix it. "The problem is they are going cut doctors and hospitals and if the doctors get that much of a cut they are not going to see Medicare patients. That's going breakdown our healthcare system."
Spinelli eventually found a doctor that would take Medicare, but he's still frustrated with the system he paid into for many years. "The most valuable thing you got is your health. Without it, life is meaningless."
Congress has until the end of the year to figure out a way to avoid the 21.5% pay cut for doctors.
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