The President assures us that we will be able to keep our doctors under ObamaCare. But what if your doctor can’t afford to keep you or his practice under that plan?

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My wife and I go to an island doctor.  We don’t live on the island, but we drive to the island doctor because he is one of the best diagnosticians in an area heavily populated by the aging and heavily serviced by docs with degrees from prestigious medical schools. 

Our doctor is a sole practitioner, with a nurse and a receptionist.  On designated mornings, he has open hours, no appointment necessary for routine ailments, ditto his nurse for shots and tests.  If he were running a tavern, it would be named “Cheers.”  Good medicine, personally practiced.

Our doctor is one of those many who have already been forced to stop taking direct Medicare reimbursement.  He can’t afford to anymore, because of the “paltry” reimbursement rates (which are generally 20% less than private insurance reimbursements).  He has gone into debt just trying, because so many of his patients are of Medicare age.

Now, you go; you pay.  What happens next for Medicare patients is explained in a handout he has prepared.  It is partially reprinted here because it represents today’s reality, and a glimpse of our collective future:

“The office staff will electronically send your claim to Medicare which in turn will forward it to your coinsurance (if you have coinsurance) only after you pay for your office visit.

“You will receive a check from Medicare and your coinsurance if you have met the deductible.  Medicare will pay you 80% of 95% of the fee for a participating physician.  Your coinsurance will send you a check for 20% of 95% of the fee for a participating physician.  Isn’t that simple!...Only the federal government could think this one up....

“Example

“You come to the office for a visit for which Medicare’s fee for a participating physician is $100.00  The limiting charge for a non participating physician is $109.25 (which is 115% of 95% of the participating charge).  You pay $109.25 at the visit.

“We file your claim with Medicare and your coinsurance and they will send checks directly to you usually in 2-3 weeks.

“Medicare will pay (if you have met your deductible) $76.00.  This is 80% of $95.00 (which is 95% of $100.00 participating physician fee).

“Your coinsurance will pay (if you have met your deductible) $19.00.  This is 20% of $95.00 (which is 95% of $100.00 participating fee).

“The net result is you have paid $14.25 out of your pocket which is your punishment for seeing me!”

The patients of physicians who charge more than the non-participating rate get no reimbursement from Medicare.  While it is difficult to pinpoint current percentages of primary care doctors who no longer accept Medicare (particularly for new patients) on a national basis, extrapolations of data would suggest somewhere in the 30 to 40 percent range.  The number is growing and will accelerate as baby boomers flood the Medicare system in coming years.  (The numbers who refuse Medicaid are even more depressing, particularly when it is understood that Medicaid is designated as the primary vehicle for insuring most of the uninsured through the various “health care reform” proposals.)

This is government-run health care insurance right now, before it applies its bureaucratic calculations to the entire market.  The calculations above, while hard to slog through, will be simplicity squared compared to what is in store for all of us – not just Medicare participants – if President Obama gets his way.

The President assures us that we will be able to keep our doctors under ObamaCare.  But what if your doctor can’t afford to keep you or his practice under that plan?