Medicare payment levels matter

In the April 14 article "Medicare's aches and pains," an 82-year-old said, "It's important for anybody to have good health, but it's more important for us (the elderly)."

Most do believe their health is the most important. For example, an overtaxed young couple with children might argue their care is more important than an 82-year-old who has had a lifetime to save. Should the 82-year-old have unlimited access to the young couple's pocketbook to satisfy his "more important" needs? The demographic problem is the 82-year-old has lived so long, and the demographics will get worse as the baby boomers age.

Medicare was never intended to be responsible for the total needs of the elderly. That socialistic national health care concept has been rejected. Remember Hillarycare? As the price of a desirable service approaches zero, the demand can approach infinity. That is why no health care program has ever come in under budget. Medical savings accounts address this. The 17 percent decrease in Medicare physician payments will have a negative impact on access. As long as Medicare beneficiaries perceive themselves as spending government money, lower costs will not happen.

A consumer advocate from APPLE , a program designed to assist the elderly in dealing with Medicare paperwork, described physician fees as "outrageous," Medicare being "too lucrative" and she also invoked the Hippocratic Oath in characterizing the cuts as a good thing that will not have an adverse effect.

First, the Medicare paperwork is also a major cost for doctors. A modest proposal: Instead of adding more expense and programs like APPLE to deal with the oppressive Medicare paperwork, why not simplify the system so programs like APPLE are not needed?

Secondly, since 1950, 63 percent of the Nobel Medicine or Physiology Awards have gone to Americans. Anywhere in the world, if you are really wealthy and really sick, odds are you will come to the U.S. for care. As for the alleged outrageous physician fees, we as a society need to decide whether we want our doctors to come from the best and brightest. If we don't care, then the solution is easy. If a 17 percent cut is a good thing, then why stop there? Why not a 50 percent cut? The few remaining physicians will be spared that "too lucrative" Medicare influence.

Since 1996 medical school applications have steadily declined. Interestingly, indentured servants were usually debt free after 7 years. Normally, a medical student has 11 to 15 years training with 100 hour weeks not being unusual. There is also marked social and family deprivation. One then starts practice and works long hours, yet another reason physician incomes are high.

The APPLE employee stated local doctors do better here because of the lower cost of living. The truth is there is a cost of living component in the Medicare fee formula and as rural physicians, we have been paid less than our urban counterparts, leading to a recruiting disadvantage.

There is an old truism about "fast, good and cheap -- pick any two." If you really want cheap, "be careful what you wish for as you may get it." Cheap healthcare is still available. Just sign a liability waiver and tell your doctor.

In the past two years my wife (breast cancer) and I (rare neurological disorder) have spent considerable time on the other side of the stethoscope as patients. We don't know whether or not our doctors were motivated to enter medicine by purely humanitarian ideals or because medicine provided them with the best opportunities to utilize their intellectual talents and provide for their families.

Frankly, my dear, I really don't care and am simply grateful they were attracted to medicine, whatever the motivation. Fast, good, and cheap. Emphasize cheap too much and fast and good will ineluctably suffer. What do you really want?

Dr. Ed Masters is a family practitioner at Premier Family Physicians in Cape Girardeau.