If you learned that 93 percent of non-pediatric primary care physicians took Medicare patients and 94 percent took patients with private insurance, you would likely conclude that Medicare is doing just fine.
Unfortunately, such data do not describe physicians’ behavior at the margin, which is what will determine future access to Medicare. The Kaiser Family Foundation/Commonwealth Fund 2015 National Survey of Primary Care Providers also asks which physicians are not accepting new patients. Its answer: 21 percent are not taking new Medicare patients, and 14 percent are not taking new privately insured patients. That is, the proportion not taking new Medicare patients is 1.5 times greater than the proportion not taking new privately insured patients.
I would encourage the Kaiser Family Foundation and Commonwealth Fund to add a little more detail to the survey, by breaking down Medicare into traditional Fee-For-Service (in which physicians are paid according to a fee schedule dictated by government) and Medicare Advantage (in which they are paid fees negotiated with private insurers), and by breaking “privately insured” into categories (especially patients on Obamacare exchanges).
It would also be interesting to learn whether or not the physicians who are saying “enough” to new Medicare patients are more likely to be in new payment models (Accountable Care Organizations) which frustrate them. (Another survey reports a wide dispersion of opinions about such reforms among physicians.)
Nevertheless, the survey is illuminating even with its current level of detail. It indicates baby boomers aging in to Medicare will have increasingly difficult access to care. One consequence seems clear: the idea of premium support (whereby Medicare beneficiaries receive subsidies to choose lightly regulated private plans) should become more politically acceptable – if not unavoidable.
This article appeared in The Beacon.