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1992: Doctors Refuse Medicare Patients

A 17 year old article from the archives of the New York Times:



April 12, 1992

Many doctors in Manhattan, Miami and other places where medical care is expensive say they are curtailing services for the elderly because of sharp reductions in the payments they receive from Medicare.

Medicare payments used to be based on the fees that doctors in an area customarily charged their patients. But starting March 1, Medicare adopted a national payment schedule that sharply narrows the gap between more expensive and less expensive places.

For example, Medicare now pays $54 in Manhattan for an office visit for which doctors typically charge a patient under private insurance $80 to $110. But doctors in Rochester, where the average charge is only $38 to $43, now get $41 from Medicare.

And the Government pays $2,068 for a hip replacement in Manhattan, compared with $5,881 charged private patients there. The Government pays $1,874 for the hip procedure in Rochester, compared with $2,978 paid for private patients by Rochester Blue Cross and Blue Shield.

Fees for Some Cut 50%

All told, Manhattan physicians must be willing to accept payments for Medicare patients that are 50 percent to 60 percent less for some common types of office visits and surgical procedures, said Amy Schwartz, associate director of the New York County Medical Society.

As a result, a number of doctors in high-cost places said in interviews that they had decided to refuse new Medicare patients. They also said they would no longer provide advice by telephone to current patients, as they traditionally have without charge, asking the patients to come in for appointments instead.

Other doctors say they are changing jobs or retiring early. And some health-care experts say one danger is that doctors might begin to charge their privately insured patients more to offset the effects of the Medicare cuts.

"I can’t afford to take care of any more Medicare patients," said Dr. Margaret Lewin, a Manhattan internist. She said her costs amounted to $329 an hour — for salaries and benefits for five medical and office assistants, equipment maintenance and depreciation, supplies, insurance and rent for her upper East Side office.

"Unless I’m willing to see 10 patients an hour, I can’t meet those expenses," she added."

If Obama-Care is going to be simply an expansion of Medicare, how will we have the option of picking our own doctors?

Why should we think that the doctors would be willing to accept new patients with Obama mandated re-imbursements?

This article was posted by Steve on Wednesday, July 29th, 2009. Comments are currently closed.

11 Responses to “1992: Doctors Refuse Medicare Patients”

  1. catie says:

    I think I read somewhere or maybe heard it on Rush that our soon to be new Supreme Court Justice has a brother who is a doctor and he refused medicare and medicaid patients. Wow, talk about elitism and they claim to be just poor folks from public housing. Guess they couldn’t wait to get away from folks like they were a few decades ago.

  2. electionhangovervictim says:

    Oblahma came to our city today to highlight the “virtures” of his health care reform. I work about 8 miles from the airport where he landed and even at that distance, I could smell the pile of bullsh*t he was about to spew on everyone.

    My head is spinning. I think I need to go lie down now.

  3. proreason says:

    “Why should we think that the doctors would be willing to accept new patients with Obama mandated re-imbursements?”

    Another slow pitch.

    Because, of course, they won’t have a choice. They can use their million dollar educations to mow yards, or they can suck it up and learn to enjoy lifestyles similar to Obamy voters.

    And climbing over their backs will be hundreds of thousands of new doctors, recruited from Acorn ranks, just “dieing” to make big bucks giving medical care to people who feasted on the carcasses of their ancestors.

  4. Georgfelis says:

    $2000 for a hip replacement? That’s gotta be a typo, typical hip replacement in the US runs around $40,000. For two grand, I doubt if you could get the doors replaced on your car.

    • take_no_prisoners says:

      The $2000 is just the professional fee for the orthopedic surgeon’s service. It doesn’t include what the hospital, the anesthesiologist, the radiologist, the lab and pathologist, and other consultatants such as the patient’s internist are paid. The figure you are quoting ($40,000) sounds like the list price for all of the providers added together. This is also inaccurate as no one gets paid the list price unless the patient is either self-pay uninsured or is the rare bird who has traditional indemnity insurance (instead of a PPO or HMO type insurance policy), which is about as rare as a zebra in Alabama. Believe it or not this is in the ballpark of what an orthopedic surgeon gets from medicare these days (rates vary from place to place–you get paid more if you are located in a big city than you do if you are in a rural area).

  5. BannedbytheTaliban says:

    PR, right again, but forcing doctors to accept whatever reimbursement the government wants isn’t about changing the doctor’s lifestyle. The doctors will simply charge the insurance companies more who will intern pass the difference off to the consumer. This will make insurance more expensive forcing more and more people on the government plan. And one day we wake up and there will be nothing but government run health care. Any mention of any other system will be erased by the ministry of truth.

    • take_no_prisoners says:

      When the reimbursment for one’s services is such that there is no money left to take home after paying the rent, the employee’s and the suppliers (i.e. the overhead) there is no choice but to close your doors and look for something else to do.

      Under Obamacare, what will eventually happen is that the only hospitals that will remain open will be located in major metropolitan areas. If care is available at all in smaller towns and cities it will be doc in the box clinics staffed by nurse practioners, physicians assistants and possibly foreign M.D.’s who will only stay there long enough to get their green cards at which time they will move to the major metropolitan areas. If you need more than a band-aid or an Rx for an antibiotic you will be referred to a hospital in a major metropolitan area. If it is some really expensive procedure, you will probably be given a plane ticket and a referral to a medical center in India, China, or possibly South America. You think I jest? Print this out and refer to it in a few years and you will be able to verify the accuracy of this prediction.

  6. BillK says:

    As I’ve mentioned before, if you ask any health care provider, they will tell you flat out that one of the reasons their prices are high is they need to charge others more to make up for the lossesthey take in treating Medicare patients.

    To use the same example I’ve used before, I’ve been told the Medicare reimbursement rate for an MRI doesn’t even cover the power used to run the machine.

    • Confucius says:


      There are a lot of reasons why healthcare is so expensive. For those with private insurance, cost-shifting is one of the major reasons.

      On average, Medicare, Medicaid and workers compensation cases do not reimburse enough to cover the costs incurred by their patients. In a typical hospital, this constitutes 50-60% of the patients.

      In a typical hospital, 7-15% of the patients have no insurance and will pay nothing.

      In general, BCBS reimbursements break even.

      The hospitals make up for these deficits by charging more those patients who are fortunate (or unfortunate) enough to have good insurance. And God help you if you have no insurance, some savings and a conscience.

      What all this means is that your medical bill likely covers you and the three who came before you. 20 years ago, the ratio was approximately 1:2. 20 years from now, the ratio will likely be 1:5–which by the way has been called by some as the “breaking point.”

  7. MinnesotaRush says:

    “I can’t afford to take care of any more Medicare patients,” said Dr. Margaret Lewin, a Manhattan internist. She said her costs amounted to $329 an hour — for salaries and benefits for five medical and office assistants, equipment maintenance and depreciation, supplies, insurance and rent for her upper East Side office.

    “Unless I’m willing to see 10 patients an hour, I can’t meet those expenses,” she added.” …

    Did anybody see to it that o-bah-blah got the memo – doctors have expenses???

    • proreason says:

      See, that’s the root problem with Obamy’s fruitcake racist opponents.

      They can add.

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