When Doctors Revolt

This week, Republicans in Congress will face the prospect of voting to cut physician reimbursement drastically. What's up with that?

There was a time when almost no one felt sorry for doctors and their ability to earn a living. Doctors could whine about it, but the public just didn't believe that they should feel sorry for a doctor making over $100,000 a year. But the average family physician's salary now may be less than that in some locations -- according to one survey, it is $72,000 a year and in other surveys the median in the U.S. is $153,000.

Given the amount of debt most doctors accumulate paying for medical school, and the price of housing in many places in the U.S., and the fact that salaries have been declining not increasing, the money issue has become a big deal.

So when the American Medical Association stood up and revolted over Congress' proposed pay cuts for doctors last week, and launched an ad begging Republicans to reverse their vote on the pay cuts, it made news. And the story was on the front page of the New York Times as well. The story is complicated and involves doctors vs. insurance companies vs. the government. And it blames Republicans for cutting doctor pay and for siding with insurance companies.

Why is this news and why should you care? You should care because in increasing numbers, doctors are dropping patients and insurance plans and Medicare reimbursement. If you are over 65 and have tried to find a doctor who will take Medicare or your particular insurance plan, you know it's a problem. And if you are not over 65, you may find that your doctor does not want you or your insurance plan any more either. Doctors feel they are seriously underpaid by Medicare and other payers. They're mad and they're not going to take it any more! Especially when they look out the window and see the big health plans getting paid more to cover Medicare patients but paying doctors less to do it. They get even madder when Republicans vote against them. It's a major revolt and the stakes could not be higher.

There are already serious shortages of some types of doctors -- doctors in emergency rooms in the U.S.; anesthesiologists to put you to sleep when you have surgery; plain old "family practice" doctors to reassure you your sore throat is not strep or to set the arm you broke while skateboarding (and at YOUR age!). And despite the fact that there are more students entering medical school than ever, the number of doctors entering family and primary care practice has declined, leaving all of us at risk of not being able to get a doctor to see us when we need one.

While doctors have been complaining about pay cuts in Medicare and private insurance plans for many years, this year is somewhat different. The cuts proposed for doctors this year are like salt in a wound, given that the health plans are being paid, by almost everyone's reckoning except theirs, more to cover Medicare patients than ever, but those over payments are not trickling down to doctors. And of course it's an election year and Congress is under special scrutiny by voters. How did Republicans get on the wrong side of this issue? How is it that Republicans are arguing for pay cuts for doctors and Democrats are not? It's too long a story for this blog, but to your local doctor, it's actually simple. It's a tipping point of sorts, and doctors are ready to hold politicians accountable. You are either for doctors or for insurance companies in their view.

Could this issue be the one to tip doctors toward supporting comprehensive health reform? Maybe even single payer? A recent survey revealed that 59% of doctors support a single payer plan that would eliminate the role of private insurers in health care. Keep your eye on this one. Who will win or lose? Doctors vs. insurers vs. Republicans vs. Democrats... VERSUS YOU.

Comments

[Linda Bergthold - Huffpost Blogger]

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UPDATE: The Senate voted on Wednesday, 69-30 to block the cuts in physician reimbursement and pay for it by reducing payment to Medicare managed care plans. Senator Kennedy came back to the Senate to be sure that the bill passed with a veto-proof majority of 60 votes. While this bill provides a temporary fix, it is temporary only. It won't fix any of the other problems I noted in my blog post -- shortages of doctors, doctors leaving practice, and shifts of costs from Medicare to private payers.

[Linda Bergthold - Huffpost Blogger]

See Linda Bergthold's Profile

For all of you who care about universal health care, solving the Medicare payment problems is pretty critical to address. What good will it do if we have universal access if there aren't enough doctors to provide the services? And for all the talk of having a "medical home" (that is, a doctor who will coordinate all your care), the current payment system just doesn't promote that. Getting educated about how doctors and hospitals are paid is a first step toward reforming the health care system. Thanks for your comments! Keep them coming!

[ElliH]

This is an important issue: Medicare is THE health insurance for most people over 65 and many disabled adults as well. If physicians won't take new ( or existing) Medicare patients, our health care system has taken another step toward dysfunction. ..a big step, that the next administration will have to fix. This proposed cut is a false economy...

Genuine health system reform would put family medicine at the center, giving internists, pediatricians, family docs, more money and responsibility. They can play in actually helping patients be healthy. Whereas the insurance companies are part of the problem...not part of the solution. Cutting Medicare physician reimbursement by 10% is a terrible idea and we should just say NO! !

[ouroborous]

I'm glad to see someone sticking up for the "rich doctors" lately. It's important to note that the folks who do the bulk of the work (family care, anesthesiologists, etc.) aren't really making all that much money at all. I have no college education whatsoever, and I make more than the low median salary you quoted. It's upper middle class, but certainly not RICH (especially if you try to live in or around a major metropolitan area, believe me). Once you add school debt and the outrageous price of malpractice insurance to that, it begins to look like a losing proposition.

Democrats would be smart to latch on to this issue.

[Chas53]

Many of us on the front lines are anxiously awaiting the upcoming vote on Medicare funding. We simply cannot absorb a 10% cut in reimbursement. It's disheartening to see that Medicare lacks the cajones to rein in profligate spending on poorly proven therapies (i.e. vascular stenting) and testing CT cardiac angiograms. Expect to see many docs departicipate from Medicare if the cuts go through. We lose money on Medicaid patients, who are notoriously prone to skipping appointments, non-compliance and lawsuits. No wonder many recent grads want to do cosmetic dermatology. Now there is something that Americans will pay cash for!!

[indygal]

What it seems to be coming down to is this: we've already had a national health care plan in place for the last several years. It's called Medicaid, and as more people lose homes and jobs, and can't afford health insurance premiums or deductibles, they will turn to the government for help. For many, the ER is their only source of medical care. Taxpayers are footing the bill from both sides: trying to pay for their own insurance while adding to the Medicaid coffers with their paychecks. At some point, the system will collapse under its own weight.

Do some research into what drug companies charge for their medicines and what the actual cost to manufacture those drugs really are. It's shameful and criminal. I understand the folks doing the research need to be paid, but this is beyond fair compensation, especially when it comes at the expense of those who can't afford to treat their illnesses.

[donewithwar]

I am one of the physicians of which you speak. It takes far too long to describe, but the bottom line is that insurance companies have been diverting money intended for health care into executive bonuses and layers of bureaucracy in the name of "managing care" for the past 15 years. While incomes drop, physicians face ever increasing regulation, reporting requirements, credentialing requirements, accountability, and vulnerability to litigation. At the same time, the number of patients without any insurance at all who turn up in emergency rooms increases. If I treat a patient for free, I assume the same practice expense and risk of litigation as for someone who has insurance. Practice expenses go up, our employees expect regular pay increases, and the final irony, the amount we have to pay for health insurance premiums for ourselves and our employees has been going up at 20 % per year.
Attorneys and private insurance executives get wealthier every year the status quo is maintained. It is time to cover everyone and at the same time, reform the tort system.