Health care is subject to laws of economics

Since Medicare doesn’t cover cost of care, it’s inevitable that many doctors refuse Medicare patients

With the inauguration of President Trump, there is renewed discussion about the cost of health care in general and Obamacare in particular. Seniors who enroll in Medicare soon find out that many physicians will not accept Medicare and decline to accept them as patients.

But why? As a recently retired obstetrician/gynecologist in Las Cruces, I can tell you.

Like it or not, medicine is a business like any other — money in, money out.

I once calculated what it cost to keep my office doors open. I stopped delivering babies about 10 years ago. My practice after that consisted of office practice with surgery one day a week.

When I discontinued obstetrics, my malpractice insurance premium fell by 50 percent. After that change, my malpractice insurance premium wasn’t that bad — only $700 per week. Yes, per week. Add to that rent, utilities, supplies and the girls’ salaries and benefits and it cost me $55 every 30 minutes to keep the office open, assuming I made nothing.

About four years ago, I had an experience that I had never had before. A retired businesswoman came to my office as a new patient for an annual exam, pap smear and breast exam.

She had just relocated to Las Cruces. She was insured through Medicare.

I don’t see a patient every two minutes. You cannot provide quality health care in so little time. She received 30 minutes of my professional time like every other new patient, including a full exam with breast exam and pap smear. It turns out she needed a vulvar biopsy.

I have been in business a long time and know how to play the Medicare game. Unless one reschedules a patient for a return visit, you will likely eat the cost of the biopsy.

However, she was there on the table ready to go and I performed her biopsy at the time of her initial visit to prevent her having to come back a second time.

When she left, she expressed gratitude for the visit and noted it was a good experience.

What happened next is what made this case so unusual.

Four weeks later, she returned to my office unannounced. She was incensed!

Not at me, but she had received a statement from Medicare and was dismayed to discover that for a half-hour of a specialist’s time I had been paid the princely sum of only $32.

What was so different was the fact that she cared enough to return to the office. “Doctor, you lost money,” she said. “Yes,” I responded. “But you can’t stay in business that way,” she replied.

I explained to her that if all my insurance carriers paid as well as Medicare did — a situation that would be true in a single-payer system that is so fiercely championed by many lawmakers — I would indeed have to close my practice.

As it is, other insurers have different reimbursement schedules. In my practice, I accepted all forms of insurance including Medicaid, military insurance (that often paid even less than Medicare) and also made arrangements that allowed me to regularly see uninsured patients.

I explained that I would continue to conduct my practice as long as I could. She opened her wallet and extended a $100 bill to me. I refused to take her money, explaining that I had a contract with the government and had agreed to accept their fee schedule as full payment.

I also explained that if I so much as touched that $100 bill, I could lose my license to practice.

Understand that many doctors refuse to accept your Medicare because it pays so little that each patient encounter results in a loss of income.

Doctors work for the same reason you do — to support themselves and their families. Much work will be required to bring down the cost of health care and still be economically viable.