No, it’s not a cookbook.  But as our society ages, lawyers should be aware of what’s happening in other areas with older Americans as well as those that impact us professionally and personally, such as DWE.

The New York Times has an article this morning about the Senate Republican’s cut of 10.6% in Medicare reimbursement rates.  The American Medical Association has launched a series of ads to fight this cut, but it remains to be seen whether this effort will have any impact.  President Bush (you remember him, he’s the guy that John McCain never talks about) says he will veto legislation restoring the cuts.

The rationale is to “rein in the rising cost of health care.”  Certainly a worthy cause, in a vacuum.  But like most overarching ideals, the devil is in the details.  On whose back will costs be controlled.  The Big Insurance Companies?  No.  Pharmaceutical Companies?  No.  The physician?  Yes. 

Consider Medicare the health care equivalent of indigent defense.  Doctors who take Medicare patients are required to accept the reimbursement rates set by Medicare, rates that have been unilaterally reduced for years.  The rates bear no relationship to the costs of a medical practice.  They just are. 

The rates paid for treatment of military and veterans are tied to Medicare, so what’s said about one applies equally to the other.

When Medicare reduces payments to doctors, fees under the military program are also reduced, and it becomes more difficult for military families to find doctors.

Congress is “playing chicken with your health care,” the Military Officers Association of America told its members in a bulletin last week.

Irony stems from the pretense that the Republicans love our military.  They wear lapel flag pins to prove it.  They give speeches about supporting the military.  Then they cut the reimbursement rate for their doctors?  They may love them, but they don’t want to pay for them.  Do active duty soldiers know about this? 

To put it bluntly, the reimbursement rates before the cut were incredibly low.  Low, as in barely meeting the cost of doing business, without being able to make a profit.  You see, health care professionals have costs too.  They have staff and rent.  They have equipment to perform tests, and it’s not only expensive, but needs constant love to keep it functioning properly.  Even the basic stuff they use in their offices, like those tongue depressors, get tossed after each use and have to be replaced.  It all costs money.  And after it’s all paid for, the docs would like to earn a little for themselves.

As the maneuvering goes on in Washington, doctors around the country have begun to reassess their participation in Medicare.

Dr. David D. Richardson, 40, an ophthalmologist in Los Angeles County, closed his practice last week to all but emergency patients and those needing surgery.

“I love practicing medicine,” Dr. Richardson said, “but I would lose more money by keeping my office open than by pulling it back to a skeleton crew. Just like a physician in the emergency room, I try to reduce the hemorrhaging.”

Did I mention caps?  Have a stroke?  You may need physical therapy and speech therapy, but they are both lumped together with a cap of $1,800.  You can walk or you can talk, but you can’t get enough treatment to do both. 

We must rein in health care costs.   Many in health care will not turn away a Medicare patient, just because it seems wrong to do so.  These are our older Americans, our mothers and fathers, grandparents, who need treatment.  We want them to feel well and enjoy life.  They worked hard, raised us, sacrificed for us and we owe them for all they have done. 

But this is true of Republican Senators as well.  Some of them had parents.  Where’s their sense of debt for their elders?  Well, given the constitution of the Senate, combined with a spectacular health plan that far surpasses anything mere mortals (other than cops and teachers) would receive, they are the elders and they’re doing just fine.

So each physician, each allied health care provider, must make a personal decision of whether to treat an older person under Medicare, and accept whatever amount Medicare decides to pay that day, even though the reimbursement rate is lower than the actual cost of treatment.  They are no longer giving only of their time, but they are now going to suffer an actual financial loss to treat the elderly.  The health care provider is paying part of the bill when the old folks receive treatment.  And old folks tend to need more treatment than most.

So be nice to the doc who treats grandma.  Chances are that she’s covering part of the bill because Medicare won’t.  And if she decided that she will no longer pay part of that bill, who’s going to serve the elderly?