Cheating Medicare

Hearing my fee, the guest announced that he was on Medicare. I explained that I am not a Medicare doctor, so he would have to pay me up front. Unlike most elderly callers, he preferred another source of care, so I gave directions to a local clinic.

Medicare pays less than the going rate for all medical services. I don’t know any hotel doctor who accepts it. Among the ninety percent of office physicians who bill Medicare, many work hard to tack on extra charges for tests and procedures and length-of-visit to compensate for the low reimbursement. This is cheating, but doctors routinely cheat Medicare. After all, they point out, Medicare cheats them.

Most doctors are conservative, so they blame Medicare’s behavior on government bureaucrats. Being liberal, I blame society. The U.S. is a democracy, and most Americans don’t want to pay enough taxes to finance Medicare adequately. No elected representative, Republican or Democrat, would dream of forcing them.

As a result, a Medicare bureaucrat behaves like any intelligent person required to pay bills without enough money. He quibbles, quarrels, delays, discovers errors in the invoice, makes partial payments and sometimes no payment at all. This infuriates doctors but allows the Medicare budget to last out the year. Paying bills promptly would exhaust the money early, infuriating the bureaucrat’s boss. 

I Love Medicare

I have collected Medicare since 2005. There’s a belief that this means I get free medical care, but that’s definitely not true. Both Medicare Part A and B have deductibles, and sensible retirees buy a policy that pays most of what Medicare doesn’t pay (and it doesn’t pay quite a lot). There is also Medicare Part D which requires a premium that pays for drugs. Believe it or not, Part D was passed by Republicans.

Being Republicans they made sure the plan met the approval of pharmaceutical companies, and it does. They love it. Part D specifically forbids Medicare from negotiating for lower prices. Other government departments such as the V.A. can negotiate. Hospitals and private health insurers can negotiate. Medicare can’t. As a result, Part D premiums, no less than drug prices, have been shooting up each year.

The result is that I pay about $550 a month for medical insurance. In exchange, I get almost no medical bills. I love it. Even though Medicare is a government program, I receive less paperwork than when I belonged to Blue Cross (even writing “Blue Cross” produces a surge of anger; I hated it). 

My brother, a physician, detests Obamacare. He is liberal and an activist, and he dislikes Obamacare because it delivers a bonanza to insurance companies with no controls on cost. His criticisms are correct, but I tell him that as premiums skyrocket the outcry will force Washington to take action.

Conservatives tell us that in European national health plans the downtrodden physician takes his orders and pitiful salary from the government. In fact, all these countries have some private insurance. In many, such as Switzerland and the Netherlands, everyone buys medical insurance from private carriers just as they do in the US. The difference is that laws closely regulate them. The carriers aren’t losing money.

Things will work out.

Warning! Make Sure You're Admitted!

This is strictly for American readers, but others will get a taste of the grotesqueries of our medical system.

Let’s say you’ve been vomiting for a few days and drag yourself to an emergency room. The doctor says you need IV fluids, so an aide wheels you to a room where you spend the night and most of the next day and then return home, feeling better.

Or you have chest pain. The ER doctor doubts that it’s a heart attack, but he wants to keep you for observation. After two days connected to a heart monitor and getting blood tests, you’re discharged, feeling better.

In both cases you’ll get a bill for at least $5,000, and YOUR HOSPITAL INSURANCE WON’T PAY!! 

Hospital insurance only pays if you’re admitted to the hospital, but remaining in a holding area for a few days or being kept “for observation” is not admission. You’re still an outpatient, so you’d better have good outpatient insurance.

If you’re over 65 and have Medicare Part A (which is free) but have decided to skip Part B (which costs $109 a month) you have no outpatient coverage. Part A only pays for the hospital. If you’re under 65 and have the usual Blue Cross or Blue Shield, you’re largely covered for hospital charges. Depending on the policy you’re willing to pay for, outpatient coverage varies. A lot. 

The solution, when the ER doctor announces that you need to stay for a while, is to ask: “am I admitted or not?”

Of course, you’re probably miserably sick or frightened (if not, maybe you shouldn’t be in an emergency room), so asking about insurance is not a priority. Woe unto you if you don’t.