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Many thanks to Joanne Stolen for laying out so clearly the reasons that Dr. Fitzgerald was forced to close her practice in Summit County. Everything that Ms. Stolen said is right on target.
As another solo practitioner in Summit County, I am facing each of those difficulties as well. I pay one person to handle my billing, and another part-term person to deal with the insurance issues that my billing person doesn't resolve. I also work seven days a week, and most of those days are 12 hours. I am not reimbursed for the hours I spend on telephone calls with my patients. Nor am I reimbursed for consulting with my patients' other physicians, or for filling out paperwork for their insurance companies, lawyers, or Workman's Compensation.
Many of my patients are on Medicare, and Medicare has not raised its reimbursement rates to primary care practitioners since 1995 . As a result, I am reimbursed approximately 35 percent of my ordinary fees for every patient on Medicare. The remaining 65 percent is simply lost. The Mayo Clinic in Scottsdale, Ariz. recently stopped taking Medicare altogether. If the Medicare reimbursement rates are not raised significantly, soon, many more practices will have no choice but to stop taking Medicare.
Insurance reimbursement is not much better these days. While the rate of reimbursement is higher than for Medicare, my staff spends hours trying to make insurance companies honor their contracts with me to pay the claims generated by my care for my patients. As a solo practitioner, I can't afford to be stonewalled on claims by insurance companies — and they know that. It is a constant challenge to obtain sufficient reimbursement to stay in practice.
A few points to add to those made by Ms. Stolen. Employer-sponsored health insurance was instituted in the Eisenhower administration. Perhaps if the people who cry out against “socialistic” health care programs realized that businesses have been subsidizing health care for almost 50 years, and can't afford to do it any longer, they would be less resistant to having the entire country subsidize health care, rather than placing that strain only on businesses.
Further, it is nonsense to criticize a single-payer government system as rationing health care. That is what the for-profit insurance companies do every day. When your insurance company refuses to pay for a particular office visit or procedure or medication, it is because the insurance company has decided that you don't need or don't deserve that health care. How is that different from what the critics say a government-run program would do?
Finally, to the critics of health care reform who fear having a bureaucracy run their health insurance, I can tell you that, while its reimbursement rates are absurdly low, Medicare is the best-run and most efficient health insurance system in the country. Compare Medicare's administrative expenses of 3-5 percent to the 15-30 percent of for-profit insurance companies. (That CEO's multi-million dollar compensation comes out of your pocket.) Compare the transparency of Medicare's reimbursement policies to trying to find out what your insurance company will or won't cover. And compare Medicare's e-filing of claims and direct deposit of reimbursements with the literally dozens of different and Byzantine claim processes of the for-profit insurance companies. A government-run health care insurance system has to be better than what we have now.
A country that fails to care enough about its citizens to provide universal health care cannot claim to be a moral one. But, even putting aside the moral issues, on a purely practical level, the current system for paying for health care cannot continue much longer, before the entire system collapses on itself.
As another solo practitioner in Summit County, I am facing each of those difficulties as well. I pay one person to handle my billing, and another part-term person to deal with the insurance issues that my billing person doesn't resolve. I also work seven days a week, and most of those days are 12 hours. I am not reimbursed for the hours I spend on telephone calls with my patients. Nor am I reimbursed for consulting with my patients' other physicians, or for filling out paperwork for their insurance companies, lawyers, or Workman's Compensation.
Many of my patients are on Medicare, and Medicare has not raised its reimbursement rates to primary care practitioners since 1995 . As a result, I am reimbursed approximately 35 percent of my ordinary fees for every patient on Medicare. The remaining 65 percent is simply lost. The Mayo Clinic in Scottsdale, Ariz. recently stopped taking Medicare altogether. If the Medicare reimbursement rates are not raised significantly, soon, many more practices will have no choice but to stop taking Medicare.
Insurance reimbursement is not much better these days. While the rate of reimbursement is higher than for Medicare, my staff spends hours trying to make insurance companies honor their contracts with me to pay the claims generated by my care for my patients. As a solo practitioner, I can't afford to be stonewalled on claims by insurance companies — and they know that. It is a constant challenge to obtain sufficient reimbursement to stay in practice.
A few points to add to those made by Ms. Stolen. Employer-sponsored health insurance was instituted in the Eisenhower administration. Perhaps if the people who cry out against “socialistic” health care programs realized that businesses have been subsidizing health care for almost 50 years, and can't afford to do it any longer, they would be less resistant to having the entire country subsidize health care, rather than placing that strain only on businesses.
Further, it is nonsense to criticize a single-payer government system as rationing health care. That is what the for-profit insurance companies do every day. When your insurance company refuses to pay for a particular office visit or procedure or medication, it is because the insurance company has decided that you don't need or don't deserve that health care. How is that different from what the critics say a government-run program would do?
Finally, to the critics of health care reform who fear having a bureaucracy run their health insurance, I can tell you that, while its reimbursement rates are absurdly low, Medicare is the best-run and most efficient health insurance system in the country. Compare Medicare's administrative expenses of 3-5 percent to the 15-30 percent of for-profit insurance companies. (That CEO's multi-million dollar compensation comes out of your pocket.) Compare the transparency of Medicare's reimbursement policies to trying to find out what your insurance company will or won't cover. And compare Medicare's e-filing of claims and direct deposit of reimbursements with the literally dozens of different and Byzantine claim processes of the for-profit insurance companies. A government-run health care insurance system has to be better than what we have now.
A country that fails to care enough about its citizens to provide universal health care cannot claim to be a moral one. But, even putting aside the moral issues, on a purely practical level, the current system for paying for health care cannot continue much longer, before the entire system collapses on itself.
