My cardiologist quit his profession and took a job as an administrator for an insurance company, reviewing heart problem claims. He was required by Medicare to charge fees as if he was practicing on a farm on the border of Mexico. However, he lived and practiced in one of the most affluent communities in America, where the cost of living is very high. Some bureaucrat designed the borders of this region for Medicare charges without regard to the differences in the cost of living inside the region. He made better money and with less stress as a bureaucrat than as a practicing cardiologist. Most of the doctors in Santa Barbara do not take Medicare due to the low fees and the amount of paper work involved.
What is happening, from the little sample I have, is that MDs are retiring, going into concierge medicine, or getting overwhelmed with work for little pay offered by socialized medicine. My dermatologist sold his practice. My pulmonologist retired. My urologist was supposed to give me a report about a cancer test. The test was taken two or three weeks ago. I'm still waiting for her to report the results to me. She is too busy and to get an appointment I have to wait almost three months. A family doctor I visited had a sign next to the clock on his wall. The sign read: “Your appointment is for twenty minutes. If you need more time, please come back.”
My new family doctor, a young one, says that many of his friends, including him, are wondering whether they made the right decision to go into the medical profession. Between the number of years required to get a degree, and the student loans they undertook to graduate and get a license, he and his colleagues face enormous personal and financial sacrifices. And the Medicare charges that have subsequently influenced their income do not justify their investment.
Doctors who are in demand because of their reputations have moved into concierge medicine. Patients sign a contract for a year and pay a monthly fee for the privilege of seeing the doctor. If you are not a concierge client, you have no access to the doctor. So, what does this all really mean? First, there are fewer and fewer doctors who are willing to get paid by Medicare. Patients that can not afford concierge medicine and must use Medicare have to put up with declining health services because the better known doctors are removing themselves from the practice or becoming expensive concierge doctors. The general population to see a doctor they might have to wait three months or longer to see one.
How did this mess happen? The intentions were pure and honorable and justifiable: All people should have medical service available to them. A decision was made based on values and political judgement, but for implementation, you must take care of those who are going to implement the decision, in this case, the practicing doctors. It should be in the implementor’s interest to implement the decision. The solution should be right for them, too. When implementation is ignored, what is being achieved is the opposite of what was intended. In this case, the well-to-do get care from the better known doctors without having to wait for a month or more to be seen, and the general population gets to be on a long waiting list to be served because there are not enough doctors. The decision which on its merits looked right and good, achieved the opposite of what was intended: It did not solve the inequality of care that it was designed to care of. May be it made the problem even worse.