Medicare revelations

I'm back.

Did you miss me?

My column has not appeared for the last eight weeks.

Life goes at a rapid pace but, for someone facing a major health crisis, the days are in slow motion. Under such circumstances one realizes how fragile life is.

My husband and I have sacrificed in order to buy the kind of medical insurance that allows us the flexibility to see the best doctor available. The Obama administration would call that a Cadillac plan. For us, it has been a necessity. For run-of-the-mill medical problems, any doctor will do, but there are times when you need an expert, the expert.

In mid-October, I traveled to the Mayo Clinic in Phoenix to undergo a rare and difficult operation. This was my first experience as a Medicare recipient. It was an eye-opener and a humbling experience.

When I first contacted the department in the specialty needed at the Mayo, I was told it wasn't taking any new Medicare patients. I was crushed. My doctor at home couldn't find anyone in the area who could put me back together again and suggested I contact this famed medical institution.

Mayo Clinic prides itself in treating the hard cases. However, people, who are fortunate enough to live in an area where the Mayo Clinic is available, often use Mayo physicians exclusively. Clearly, times are changing.

After making my case, an appointment was made with the expert I so desperately needed and surgery was scheduled. While going through the preop testing, my husband turned on the local news to discover the West Valley Mayo Clinic, which serves many retirees in the Phoenix area, would no longer be a Medicare provider for physician services. Senior citizens were dismayed.

The letter that went out to these Medicare recipients also stated they would not be able to transfer to another Mayo facility. "The challenge we have had for some time with Medicare reimbursements is not unique to Mayo," said Michael Yardley, chairman of public affairs of Mayo Clinic in Arizona. Indeed, it is not. That is why more and more hospitals and physicians are declining Medicare.

Medicare simply does not support the cost of doing business at a facility that provides quality care. Those that take Medicare patients have to make up the difference with patients who can afford to pay their own way or have quality health insurance. When a facility becomes dominated by Medicare patients, that facility has to decide if it wants to stay in business or not. It's gotten so bad, the Medicare Payment Advisory Commission reported nearly 30 percent of the 2.6 million Medicare beneficiaries seeking a new primary-care physician between September 2007 and October 2008 had trouble finding one.

When I became eligible for Medicare, I picked up a supplemental to cover the charges Medicare didn't pay. I expected my providers would be paid in full. Not so. Hospitals are limited to what Medicare approves and doctors are not allowed to bill more than 15 percent over what Medicare approves. Medicare-approved charges are thin, way too thin.

Mayo Clinic is nonprofit. That means the cost of my surgery was less expensive than it would have been elsewhere. Nevertheless, the hospital was forced by Medicare to write off two-thirds of the expense incurred. That is an outrage!

We pay into Medicare all of our working lives, and when it is time to receive this insurance our providers are shortchanged.

One primary-care doctor reported he gets roughly $15 for every Medicare office visit. When you consider the cost of the office, paying the staff and the malpractice insurance, doctors are barely getting by or going in the hole with each Medicare patient they see.

Despite this fact, Medicare is going broke. To make matters worse, the so-called health-care reform bill in Congress calls for $500 billion in cuts to the program. Democrats also want to lower the age of eligibility to 55, putting even more strain on the system.

Politicians pushing for government-run health care tout Medicare as a success and they won't be happy until everyone is under a government program.

Many actually believe that when the government takes over health care we will all receive more for less. The truth is we will receive less and it will cost more than we can possibly imagine. Many, who at this time would be saved, will pay with their lives.

Those of you who expect to get something for nothing, check the Medicare reimbursement rate in your state and do the math, if you dare.