- - Friday, November 2, 2012

Americans may not like to hear that Medicare is at risk from Obamacare, but the rationing has begun already. At a talk I gave recently, three patients told about their experiences.

One woman said she can no longer obtain her two kinds of eyedrops. Another complained that her doctor does nothing except type into a computer. When one patient needed more than 15 minutes, she was told to make another appointment because others were waiting and the doctor could not afford to get behind schedule.

In the beginning, Obamacare was going to take a mere $500 billion out of Medicare to fund contraceptives and other things for young people. Now the amount is $716 billion. Supporters of the legislation argue that Medicare is not allowed to cut benefits or ration care. Technically, they are correct — its only tool is to cut the amount it pays doctors, hospitals and others who provide real goods and services.

So what? Doctors already make too much money, right? They make more than the average American, more than doctors in other countries and probably quite a bit more than most seniors on Medicare ever did. But cutting into doctors’ profits will impact patients and quality of care. Patients must understand you get what you pay for.

First, doctors spend so much time typing into computers in order to save themselves trouble down the road. They get paid by the documented “bullet point.” If they pick the wrong code out of tens of thousands, they could face tens of thousands of dollars in penalties, and even prison.

Obamacare intends for all medical records to be computerized so bureaucrats can scrutinize everybody’s care to be sure it meets all the guidelines. New “payment methodologies” will judge whether doctors are doing their part to eliminate the 30 percent of care deemed “unnecessary” or to reduce “disparities” (some people getting more than their “fair share”).

With Obamacare, doctors’ administrative costs will go up so much that large numbers of independent physicians will retire or join the throng already signing up to work for hospitals and big clinics. Reformers like that. For one thing, employed physicians do about 25 percent less work.

Doctors are dipping into their life savings to pay their staffs, and they risk penalties for not meeting Obamacare targets. Even if you think they make enough money, patients need to recognize that at some point, doctors will quit sacrificing their personal well-being. Arizona dermatologist Joseph Scherzer posted a sign on his office door in 2010: “If you voted for Obamacare, be aware these doors will close before it goes into effect. Unless Congress or the Courts repeal the bill.” Now retired, he has time to compose music for the saxophone.

The people we should worry about most are Medicare patients. Eighty-year-olds likely already have received three times more from the system than they put in. Whatever they contributed to “their” Medicare was used immediately for benefits to previous retirees or other items in the federal budget. What current beneficiaries receive comes from the paychecks of younger workers, whose future has been blighted by the federal policies today’s Medicare generation voted for. Those workers might not be too sympathetic to their elders’ woes.

Seniors’ anger may well be a sign of fear. One of the first casualties of socialist redistribution is compassion.

Dr. Jane M. Orient practices internal medicine in Tucson, Ariz., and is executive director of the Association of American Physicians and Surgeons (aapsonline.org).

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