"I'm a Medicare Patient. Please Don't Hate Me!" [View all]

[McCamy Taylor]

Last edited Sat Jun 21, 2014, 06:13 PM - Edit history (1)

Those who aren't on Medicare might be surprised to discover that it is next to impossible for some folks on the insurance program to find a doctor. If you are a healthy, wealthy senior, you should have no problem. You'll be able to afford traditional Medicare with a traditional Medicare supplement--those will open many doors, especially if you live in an urban area with lots of providers. Or, you can hire one of the concierge doctors, who sign up to treat a handful of people. If you are wealthy enough, you can even go outside Medicare altogether and pay cash---though most rich people that I know are very tight with their money and will try anything before they resort to this one.

However, if you are an extremely sick Medicare patient and/or you are poor---sickness and poverty often go hand in hand in this country---you may find that there are no doctors willing to accept the extremely meager reimbursement that your Medicare so called managed care insurance pays them for coordinating your very complicated and time consuming care. You may find that the only place you can get an appointment is at the local "free" clinic or charity hospital, which is required by law to accept all comers. And you may find that even here, you are not wanted, since most of the poorly paid, overwhelmed physicians would rather see 40 somethings with allergies than spend an hour wading through your medical records, coordinating your care with your cardiologist (heart failure and CAD with Afib on Coumadin), your gastroenterologist (GI bleeding controlled by double dose Nexium), your endocrinologist (severe osteoporosis) and psychiatrist (a whole handful of medications). Did I mention your breast cancer? It's in remission. And your kidneys shut down whenever you get pneumonia which is every winter. Your insurance keeps changing its formulary so you keep running out of the medications that keep you alive, so your doctor's nurse or your doctor spend hours on the phone every month changing your meds or appealing a denial of coverage from your insurer which is doing its best to drive you off its Medicare managed plan and on to its competitor's Medicare managed plan.

Why did you sign up for a Medicare managed care plan if it is so yucky? Because it was the only one you could afford. You are poor. And sick. You really need to use your insurance. Deductibles will kill you. So you chose the plan with the least out of pocket, not realizing that it is also the plan that throws up the most barriers to care in the form of limited reimbursement for providers and limited treatment options---

Does that even make any sense?

Our nation is at war with sick people. Correction, the private insurance industry which makes a bet that it will take in more in premiums than it pays out in claims is at war with sick people. And somehow, the private insurance industry did not just get itself a seat at the table of Affordable Care and Medicare and Medicaid. In some places, it is the table. And the chairs it has reserved for the chronically ill are the ricketiest, flimsiest chairs it could find, and it has its employees stationed behind the chronically ill ready to pull those chairs out from under them at any moment. And pretty soon, private insurance is going to take a chunk out of the VA----the VA's funding, that is. Not the VA's work load. Have you seen Tricare rates?

Where was I? Oh yes. I was vomiting blood into the toilet, because my insurer decided to stop paying for my ulcer drug this month on a Friday and it is Sunday and my doctor won't be in until Monday to change my prescription. I should stop my blood thinner, but if I do that, I'll have a stroke. Here. Let me wipe the blood off my lips. I'm lucky to have a doctor. I waited nine months to get my appointment at the county clinic. No private doctor in my community will accept new patients on my Medicare plan. I had been getting my "care" from the emergency rooms, which can not turn anyone away, but they were getting tired of seeing me. I worry that my doctor has so many patients like me and keeps getting more and more. It is getting hard to schedule an appointment with him. He is booked out two months in advance. My old family doctor, from the days when I was young and healthy, could get you in that same day or at least that same week. And everyone in the waiting room looks like me---prematurely aged, tired, tied to an oxygen cannister and a walker with a huge bag of medicine. Just going through all those drugs must take 15 minutes. Most doctors are in and out of the room in 15 minutes seeing an "average" patient---

Oops. There goes the stomach again. I think I've lost enough blood that the ER doctor won't think I'm a hypochondriac for coming in by ambulance. When the clerk asks for my insurance info, I'll hand her my Medicare card. In the old days, that used to mean you were insured. Now it means that the doctor will groan and think about how little he will be paid for how much he will have to do.

Please, don't hate me, because I am a Medicare patient.

P.S. Edited so that I can remind folks at DU that I'm a doctor and my health is great. This is me sharing some of the things I know my patients would tell you if they could afford a computer and internet access.