Having spent a fair amount of time lately writing and talking about two particularly critical medical issues, my only viable current solution is to hide under the bed. But I'm not sure that's there is room for me and the dust, so I'll just vent here.
We are headed for big trouble in two areas of our health care. I don't know which is worse.
First, in the absence of a sudden congressional agreement on a pending bill, the Medicare reimbursement for doctors will automatically drop by 27% by at the end of this month. It will be a very bad time to be 65.
A 2011 survey conducted by the Medical Group Management Association polled over 93,000 doctors about how they handle Medicare patients-- now and if the cut goes through. Right now, over 95% of the respondents accept Medicare patients. But if Congress does nothing (something they excel at), the numbers change in a big way.
In that event, 31 percent of the respondents said that they would stop accepting new Medicare patients, and another 45 percent said they were uncertain. Let's say that the undecideds split evenly when it is time to decide. This will mean that more than half of the doctors in the US will stop seeing people, simply because they happened to turn 65.
Thirty-five percent of the respondents said that would reduce the number of appointments for existing patients, while 51 percent said they would do so for new patients. Nine percent said they would stop treating existing patients entirely.
This ain't good. And it's already happening. A number of recent stories have looked at what seniors face even before the end of the month. One story in particular was particularly awful. A senior woman in Connecticut spent the better part of a day just trying to find a doctor that would see her. The first four offices she called said they were no longer accepting Medicare patients, and the rate cut hasn't even taken place. Pretty horrifying.
Another big mess is the continuing, or maybe growing number of essential, generic drugs that are unavailable because of shortages. Last August I wrote an op-ed in The New York Post about people suffering and dying because their doctors or hospitals were unable to get staples such as epinephrine, morphine, antibiotics, cancer drugs and general anesthetics. There are about 250 drugs in short supply, and that number has been growing every year.
The only "remedy" announced since then was an executive order from President Obama. He directed the FDA to: 1) collect information about impending shortages and work with manufacturers to at least be aware of the shortages; 2) speed up inspections of manufacturing facilities (pretty much impossible, since they are drastically short staffed) and 3) work with the Justice Department to identify instances of collusion and price gouging. The FDA has no power to force any company to make anything, and all the inspections and criminal prosecution in the world won't change this.
So, rather than do anything useful, the administration seemed to be more interested in punishing price gougers, who were raising prices on drugs in short supply by absurd amounts, since desperate hospitals had no choice but to buy them. Hardly an ethical business practice, but perhaps we should worry about the shortages first and market abuses later. And one could argue that the required advance notification of impending shortages will make the problem worse by tipping off unscrupulous buyers to hoard drugs that will soon become unavailable.
The answer to this problem is not at all obvious. Many very smart people have been discussing this and there is no simple solution. Although a good place to start might be to lift the price controls on generics that started the problem. The shortages consist mostly of simple generics where there is little or no profit to be made given price constraints. Seems pretty simple, no? But that would involve doing something to help drug companies-- a political no-no if ever there were one.
Pay attention to this. It will only get worse. The hatred for the pharmaceutical industry is so strong that it is now impossible to get even necessary things done, should there be any hint that a profit will be made. Perhaps some of our political leaders will learn the hard way about how the perpetual demonization of an industry will come back to haunt them. Maybe when people with heart attacks start showing up in the ER only to find that they are short on epinephrine, saline and morphine will they belatedly realize that government policies, made in the name of affordable medicine or simply for political expedience, weren't such a great idea after all.
