In Our View: Crisis Is Growing

Medicare status quo complicates health care access for senior citizens



Statistics from senior citizens and projections about baby boomers loudly proclaim that Congress and President Obama are moving far too slowly in solving the health care and health insurance crises. Columbian staff writer Paris Achen presented some compelling numbers in Monday’s paper.

Only about 72 percent of 6,200 physicians surveyed in Washington were accepting Medicare patients in 2009. Anecdotal evidence seems to indicate that seniors usually don’t have much problem with access to health care as long as they remain in a community. But if they move to another city, many have great difficulty finding a doctor who accepts Medicare. A Clark County Medical Society official said she receives about a dozen calls a day asking for names of doctors who accept Medicare.

From the physicians’ perspective, the reluctance is understandable. A doctor faces at least four problems with Medicare patients, none of which have anything to do with the individual patient:

Medicare payments authorized by the government are about half of the bill’s charges.

Accepting Medicare patients requires wrestling with the federal bureaucracy. If charges are not filed precisely, payments are not made. Telephone calls for explanations often produce only lengthy and inefficient conversations.

As bad as the problem is, it could get worse. Congress planned to decrease Medicare reimbursement rates by 21 percent in January but delayed the decision. A 29 percent decrease is scheduled for January 2012 if Congress doesn’t act. In Achen’s story, Ingrid McDonald of AARP Washington said, “This has happened over and over, and each time, Congress just puts a Band-Aid on it.”

The system is wildly variable depending on region. In the Portland hospital referral region, which includes Clark County, the average Medicare payment was $5,278 in 2007, compared with a national average of $6,611.

For now, the strong recommendation is for people to find a primary care physician before becoming eligible for Medicare. Doctors are unlikely to drop patients who become eligible for Medicare. But that’s not a reliable solution for seniors who want — or need — to move to other cities. That freedom ought to be available for them.

For all of the uncertainties about competing solutions in the health care and health insurance crises, this much is certain: The status quo is unacceptable.