Matthew Yglesias opines:
[Medicare] providers are paid enough to make it worth their while to see Medicare patients, but much less than they’d like to make. The result is not a perfect program (far from it) but this particular aspect of Medicare is an example of big government at its best—serving clients’ interests rather than those of providers.If that were true, presumably most potential providers would have remained in the Medicare system. In fact, however, the low reimbursement rates Yglesias calls "a feature not a bug" in the system are increasingly driving providers to opt out of Medicare, as the NYT reports:
Of the 93 internists affiliated with New York-Presbyterian Hospital, for example, only 37 accept Medicare, according to the hospital’s Web site. Two trends are converging: there is a shortage of internists nationally — the American College of Physicians, the organization for internists, estimates that by 2025 there will be 35,000 to 45,000 fewer than the population needs — and internists are increasingly unwilling to accept new Medicare patients. In a June 2008 report, the Medicare Payment Advisory Commission, an independent federal panel that advises Congress on Medicare, said that 29 percent of the Medicare beneficiaries it surveyed who were looking for a primary care doctor had a problem finding one to treat them, up from 24 percent the year before. And a 2008 survey by the Texas Medical Association found that while 58 percent of the state’s doctors took new Medicare patients, only 38 percent of primary care doctors did.
As long as below market reimbursement rates remain a feature of Medicare, this trend is likely to continue. Since expanding Medicare probably will increase pressure for reimbursement cuts rather than reducing it, the proposed health care deal is unlikely to prove to be "big government at its best."
The WaPo quipped this morning that "the only thing more unsettling than watching legislative sausage being made is watching it being made on the fly." Delicious. The editorial goes on to warn, as I did the other day, that:
... the last-minute introduction of this idea within the broader context of health reform raises numerous questions -- not least of which is whether this proposal is a far more dramatic step toward a single-payer system than lawmakers on either side realize. ...
Presumably, the expanded Medicare program would pay Medicare rates to providers, raising the question of the spillover effects on a health-care system already stressed by a dramatic expansion of Medicaid. Will providers cut costs -- or will they shift them to private insurers, driving up premiums? Will they stop taking Medicare patients or go to Congress demanding higher rates? Once 55-year-olds are in, they are not likely to be kicked out, and the pressure will be on to expand the program to make more people eligible. The irony of this late-breaking Medicare proposal is that it could be a bigger step toward a single-payer system than the milquetoast public option plans rejected by Senate moderates as too disruptive of the private market.
