In the midst of hot debate about access to care through a single payer system or a public plan (opponents say there will be none), the report actually shows that people on Medicare have very little problem accessing physicians, and that between 2000 and 2008, more physicians than ever accepted Medicare assignment as their entire fee for service, even as their reimbursements went down.
Physician fees have been limited to keep Medicare sustainable for a longer period of time.
Over the last several years, rapid spending growth in Medicare Part B services—driven in part by growth in physician services—has heightened concerns regarding the Medicare program’s fiscal sustainability… Medicare fee-for-service (FFS) pays for more than 7,000 physician services through an annually updated fee schedule. Since the early 1990s, Congress, policy analysts, and groups representing physicians have periodically questioned whether efforts to control spending by limiting increases in physician fees could undermine beneficiary access to physician services.
…. annual updates to physician fees have varied and produced a 4.8 percent reduction in physician fees in 2002. Congressional and administrative actions averted subsequent reductions in physician fees for 2003 through 2009. However, concerns about access remained as the fee updates during this period did not keep pace with the growth in Medicare’s estimated cost to physicians for providing their services. Under current law, Medicare’s fees to physicians are projected to be reduced by about 21 percent in January 2010.
The GAO constantly monitors the Medicare beneficiaries’ access to doctors. What they’ve concluded is that “uncertainty about physician fees has not been accompanied by reduced beneficiary access to physician services.”
In other words, doctors have not dropped out of Medicare because fees have been lowered. In fact, more doctors are accepting Medicare than ever before. So saying that doctors will not participate in a public option seems to be inaccurate.
together, the three types of indicators we reviewed show that Medicare beneficiaries experienced few problems accessing physician services. Small percentages of Medicare beneficiaries reported never easily obtaining appointments; measures of beneficiaries receiving physician services increased nationwide from 2000 to 2008; and indicators of physician willingness to serve Medicare beneficiaries and to accept Medicare fees as payment in full also increased from 2000 to 2008.
If anything, Medicare beneficiaries are getting more access to care than people in private plans, and may in fact be over-using medical services in some areas of the country.
And why might this be? Partly because Medicare pays on time, if sometimes less than private insurance. It’s dependable. Partly because physician practices are always composed more of elderly people than of young people, except for certain obvious specialties, and if you are trying to run a viable practice it’s suicidal to exclude Medicare. And partly because physicians are in the business of caring for people, and they don’t want to exclude large segments of the population.
Food for thought.