CostRx: Health Cares for Medicare Patient?

In the April edition of CostRx, regulatory consultant and former Food and Drug Administration physician Jean Fourcroy comments on the ethics of the increasing trend of physicians turning away Medicare patients.

I am a Medicare patient and a physician. Since I am a Medicare patient, I do not have a doctor. As a retired government worker living in the Washington, D.C., area, I am part of a large and growing population with limited access or second-rate healthcare. In the United States, we are unique in believing that healthcare is not a right for our citizens, but as a physician I find this troubling.

I went to medical school to be trained to provide healthcare and I still provide care in a military setting. My oath of allegiance to medicine seemed to include a provision that I was to provide the best of healthcare within my ability. I am respected and honored in my profession and yet, the tenth doctor I saw in December of 2005 (the first nine turned me down at the receptionist desk because I am a Medicare patient) looked at me and said, I don’t take patients like you. Nor did she care. Nor would I have trusted any decision she made.

Why do we have this problem? Access to healthcare, or even important preventive services, are not a right in this country. We do not believe that the health of our citizens is important for the future of our country — but it is. More importantly, the doctor’s office has become a small-business enterprise. They must manage a store on the sales they make. They can’t afford to take any chances on reimbursements that are too low, e.g. Medicare, or that take forever. Since Medicare sets the fee, it cannot be rectified by my Blue Cross insurance. Running a doctor’s business may be so tight that often the staff in a doctor’s office is not provided healthcare benefits. It would be outside the business plan.

A 2002 review from the national Center for Policy Analysis suggests that in the United States, only 42 percent of doctors accept new Medicare patients and 47 percent of the physicians that accept Medicare patients spend less time with the patient. (Reference www.ncp.org). Listening to the patient has truly become a lost art.

Should doctors be part of the process of payment at all? Should there not be an ethical boundary between the payment, the patient, and the doctor as in the VA and military system? Are all decisions made in the doctor’s office made on medical need or business plan? I personally believe that there should be an ethical chasm between the care of any patient and the reimbursement of the office. I have always felt it was my personal payback for the privilege of being a physician.

I have been worried that the broken medical system is only a reflection of a broken country. A broken health system can only lead to future costly disasters. It is my belief that only a single payer system will bring healthcare back to reality.

Jean Fourcroy is a regulatory consultant in the areas of urology and endocrinology. She worked for several years as a medical officer with the Food and Drug Administration in the agency’s drug and medical device centers. Fourcroy received her M.D. from the Medical College of Pennsylvania and her Ph.D. from the University of California at San Francisco. She completed surgical and urology residencies at George Washington University Medical Center and earned a masters degree in public health from the Medical College of Wisconsin.