I love old people, but I will not accept Medicare

Medicare

I love caring for patients—young and old. And though I may not accept your insurance, I will always accept you. I’m still happy to care for Medicare patients even though I opted out of Medicare on Independence Day 2006. Why don’t I accept Medicare? Let me fill you in.

I do not accept Medicare because:

Medicare treats physicians as criminals—guilty until proven innocent.

Medicare warns patients on their billing statements to turn their physicians in for suspected fraud.

Medicare demonstrates no transparency in the flow of taxpayer money through their program.

Medicare may reimburse physicians so little that we lose money with each appointment forcing doctors to go bankrupt (or run Medicare mills with ramped up volume and quickie visits to make ends meet).

Medicare claims are more complex than any other insurer with more billing codes and rules and regulations that require hiring a team of staff to remain compliant or else . . .

Medicare regulatory codes by which physicians must abide is 130,000 pages long! (US Tax code is only 75,000).

Medicare requires compliance with more unfunded mandates and administrative trivia than any other insurer.

Medicare penalizes physicians financially if we don’t use a Medicare-approved computer system and electronic health record.

Medicare penalizes physicians financially if we don’t electronically submit prescriptions the way Medicare demands.

Medicare threatens doctors every year with all sorts of financial penalties if we don’t do what they (non-physicians) think we should be doing.

Medicare audits may suddenly destroy a medical practice and a physician’s life as described by Dr. Karen Smith:

Medicare abuses and bullies doctors.

This is no way to treat people who have dedicated their lives to helping others.

How to opt-out of Medicare.

Pamela Wible, M.D., is a family physician who pioneered the first medical clinic designed by patients. Watch her TEDx talk on ideal medical care. And her TEDMED talk Why doctors die by suicide. Photo by GeVe.

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52 comments on “I love old people, but I will not accept Medicare
  1. Mary DeForest says:

    Yes- I’m allergic to acetaminophen, so I can’t take Oxy or Vicodin. Medicare doesn’t want anyone to use codeine. That’s about the only pain killer that I can tolerate. because of medicare-I had part of my nostril cut out and resewn to my cheek, the inside of my nose scraped out, a section of my upper lip cut out, along with a strip of tissue between my nose and lip removed during a biopsy for cancer. I wasn’t given anything. I learned never get a procedure done at the end of the week, and ask a doctor if he/she is under any type of investigation. Nobody believed me that I wasn’t given a prescription for pain killer or they’d only offer a script for Oxy, which I turned down, I didn’t need to get sicker. It was almost a week before I could see my doctor to get a referral to oncology. New tumors popped up- a huge one in my lip.
    2 things were going on- one was a burning rage and hate toward American medicine, and I can control pain some what with self-hypnotism. They called me a dope addict!!

    My PCP offered me pain killer- It hurt to talk-I didn’t want to argue about Oxy. I told him that he and all other doctors could just go to —-. The worst of the pain was over with. So he put in my chart that I’m a dope addict, and I get street drugs. What type of dope addict turns down a bottle of Oxy? I despise the Medicare and formulary board so much. If a medical doctor feels that a patient needs something, and the patient pays for it, I do not understand why Medicare steps in and tells the doctor that he can’t write the prescription. I’ve been at war because I can’t process T4 in synthroids and convert to T3. Then they put my doctors under investigation or counsel them.

    My ENT spent almost an hour with me-what to do with future sinus infections, how to handle this nose and sinus, etc. He stood at check out slumping over- and he said, “All of that-it’s only education.” I looked at him and said, “IDC 10” He stared a minute, and nodded. He’s keeping me from being in agony and helping prevent infections. I had one, where the sinus drainage was eating holes in the nasal surgery sites. And they don’t want to pay him anything. Medicine is being turned upside down-the government doesn’t have the right to say what non-narcotic meds I can have.

  2. Jim Anderson says:

    I agree with most of what Dr. Wible states. However, as an administrator, I found that most of the insurance plans that are on the market are more difficult to deal with than Medicare. While Medicare reimbursement is low on the west coast, the reimbursement on the east coast is very high. Most of the requirements that Medicare imposes on it’s providers are required by most (if not all) the commercial insurance companies and they
    (commercial carriers) are much more capricious about their rules than Medicare. Overall, I would much rather deal with Medicare as an administrator than a lot of the plans that are in the market.

    • Pamela Wible MD says:

      Jim ~ There is regional variation in reimbursement and insurance idiosyncrasies. Here in Oregon I find most commercial insurance companies a pleasure to work with. Rarely have I had any problems. The Medicare audit video in the above blog instills fear that no amount of reimbursement can counteract. Auditors come after physicians not administrators so your liability is shielded by us.

      • Anthny Candelmo says:

        I LOVE YOUR INEQUIVACABLE ELOQUENCE, DIPICTING THE DILLEMAA THAT WE ALL FACE WITH MEDICARE. THANK YOU FOR THE TRUTH.

        RESPECTFULLY YOURS.
        With LOVE
        anthony

  3. Wesley McEldoonMD says:

    I am recently retired now so I am no longer in active practice, but when I was in active practice I had to have 4 employees to keep up the paperwork.

    Then I switched to a boutique model, I saw cash in advance patients only and I gave them a superbill and a referral to a private billing clerk if they wanted help.

    I also charged $25 to answer a phone call with a limit of 2 calls per week

    My patients had to agree with this in writing go elsewhere

    I didn’t loose any patients because of this.

    • Pamela Wible MD says:

      Yep. Patients want a healthy happy doctor. If we become victims to the system we are not really healers, are we?

      • ANTHONY CANDELMO says:

        I LOVE YOUR attidue as well as your inequvicable eloquence,presenting the current diLlema that,s patients aND doctors are faced with.

  4. Alan Burns says:

    So you are willing discriminate against older Americans because it might cost you more time and effort. I get medical treatment because the only way I can afford it is through Medicare. SHAME ON YOU. What about The Hippocratic Oath? Or does that only apply when it is profitable.

    • Pamela Wible MD says:

      I do not discriminate against anybody and am happy to see anyone regardless of their insurance. Have never turned anyone away for lack of money, age, sexual orientation, religion, or race . . . . I actually love complex patients and have spent up to 2-3 hours with folks for appointments. And I do house calls . . . Please read the article again as I think you have misinterpreted it.

      • Nicole Bumgardner says:

        Dr. Wible, I just saw the Kickstarter campaign and now I know of at least one of the things you are doing to improve the state of our healthcare system today. The Do No Harm film and all the people you help every day with the suicide hotlines are just incredible. I am so surprised I had not heard your name before. You are making an incredible difference. While I don’t agree with the way you’ve chosen to deal with Medicare, it’s your choice as a practicing physician, just disappointing. I can honestly say, however, seeing some of the other things you are doing totally makes up for it for me. I don’t say that often. With everything else you’ve got going on that’s above and beyond, if the Medicare frustration is where you choose to cut back, so be it. 🙂

        • Pamela Wible MD says:

          Thanks Nicole for the vote of confidence 🙂 I never turn anyone away for lack of money so all who come to my door are welcome. I wish Medicare woud be less onerous and easier on docs. It IS a great program for patients.

      • Sandra Cimino says:

        Yeah, you’ll help those who can pay you. You won’t turn anyone away, but you’ll send them horrendous bills that will bankrupt them. I’m on disability and have been treated like garbage by doctors like you who “medicare shame” their patients and low-key shame them for something that is not their fault. Just state you only want to treat the healthy and wealthy. I’d actually respect you more. When greed and politics eclipse a dr’s focus on healing, perhaps that dr. should examine his or her own motives for targeting certain groups of people.

        • Pamela Wible MD says:

          Sandra you seem very distressed. Just to recap: I have never turned anyone away for lack of money. I have never sent anyone to collections.

    • Nicole Bumgardner says:

      I agree. Yes, Medicare system is broken. The entire American healthcare system is broken. I would rather read an article that tells how you’re helping to improve the state of the healthcare system of our nation, not how you’re appealing to your own needs and wants which might not be in the best interest of all your patients/potential patients. Just my honest opinion. Sorry.

  5. harry guda says:

    this is for dr. wible
    I am very impressed with your position on medicare….
    I think we need to start standing up for what we see as right…
    from an old medical doctor

    • Pamela Wible MD says:

      Thanks Harry! That means a lot from an old doctor and a current Medicare beneficiary. Do you remember practicing medicine before Medicare? I’d love for you to share what those days were like. Thanks! Pamela

  6. Susan Morris says:

    I read this piece on Dr. Pho’s blog a couple weeks ago and was extremely frustrated that comments were no longer being accepted. I’m glad it took that long to find your own blog because it gave me time to cool off–a little.

    Medicare needs fixing. The behemoth’s systems have been screwed up for years. But face it, Medicare is just part of the problem, because our entire healthcare system needs fixing.

    In the meantime, poor access to care contributes significantly to our lousy standing in outcomes when compared to other industrialized countries. (Yes, I’m all for socialized medicine–even with the Medicare mess.) But the medical and pharmaceutical industries are the bigger problems. You can fix Medicare. But you can’t fix greed.

    I appreciate the fact that you’re a good advocate for yourself and other physicians. It’s a damn tough field. But someone’s missing from this dialogue. A lot of someones–patients, you call them. I prefer to look at them as people.

    Yes, you love “old people.” If they have the cash to pay you up front. You come from a family of doctors. Does this blind you to the fact that many, many people don’t have that kind of cash laying around?

    Have you considered the skyrocketing costs of treatment? There was a time when people could pay for health care out-of-pocket. But those times are long gone. You can’t lay the blame for that on patients. The mantras of malpractice insurance, the cost of technology, the cost of developing new drugs–they’re stale and lack credibility. How much money is spent on lobbyists and lawyers who protect the industry’s interests?

    This is why many of us do/will need to rely on Medicare. We have no choice.

    My husband’s recent illnesses, acute constrictive pericarditis that defied diagnosis, stage 3a prostate cancer and a detached retina in less than one year, were not the result of lifestyle factors. He has had five surgeries in the last year and more tests than we can keep track of. (This is another story–a very long and frustrating story.)

    Now we have very expensive health insurance. Yet we have more than $200,000 dollars in uncovered expenses/copays. I just canceled an appointment for an colonoscopy because, though we have insurance, the anesthesiologist is out-of-network. That’s $500 out-of-pocket up front. I don’t feel I can add to our medical debt.

    That’s just our story. There are so many more.

    I watched the video you provided. It surely wasn’t pleasant for the doctor. But abuse? Come on! Medicare rules are crap. Why doesn’t your industry work to improve them?

    But doctors like you who won’t see Medicare patients only advance the problems. You limit our access to care. Many of us have to do without. We skip preventative care. And many of us get sick, wait too long for effective treatment, and end up burdening our families with horrendous costs for end-of-life treatment.

    You clog our emergency rooms with people who don’t belong there but have no choice. Resources are being tapped that should be used for people with emergency health problems. And cost? Astronomical. Unnecessary. (Our community’s largest clinic won’t see its patients for follow-up care after an accident. They insist that folks go to the ER because they don’t want to deal with the insurance companies and workman’s comp. Continuity of care? Cost effective? Phht! And the burden on the hospitals is obscene.)

    So, I’m glad you like the class of patients who you refer to as “old people.” But it really doesn’t seem you care for the people who need care. Unfortunately, you’re not alone. Lives are lost. Money is wasted. People who are ill have the unnecessary added stress of dealing with this crap. And overall, out health outcomes suffer.

    • Pamela Wible MD says:

      Hi Susan ~ I see anyone who wants to see me regardless of their insurance. Regardless of their income. So I never turn anyone away for lack of money and that includes people on Medicare.

  7. jerry cordell says:

    A doctors office in TN said they do not accept Medicare I said I would pay cash then and she stated they could not do that because it would be insurance fraud, Is that true?

    • Pamela Wible MD says:

      It is not fraud if they have officially “opted out” of Medicare like I and other doctors have. It is only fraud if they still accept Medicare payments and then take cash from Medicare patients. They must still have some Medicare patients (maybe they are not taking NEW Medicare patients?) and thus must be taking Medicare payments from the government. You either opt out of government payments OR you continue taking them. You can only take patients’ cash if you have opted out. There is always a chance the woman on the phone was giving you partial or incorrect information.

  8. Chris says:

    No matter how reasonable your listings are, as an insured I would choose not to go to your place even once. Like the others said above, you are just one of those who added to the healthcare problems. Arguing that you never turned anyone away doesn’t moralize your position. Any logical person could easily figure it out that a doctor taking patients without insurance/cash would only be bankrupt unless you just did it once or twice for fun. Facts never lie!

    • Pamela Wible MD says:

      As in all of life the haves buffer the have-nots. My practice cares for all. Some can pay more and others can’t. Nobody is turned away for lack of money in 10 + years. Those are the facts.

      • Nicole Bumgardner says:

        Can you honestly tell us that you do not send medical bills to collections if the “have nots” have not paid? Do you just write those little nasties off or are you like the rest off America’s private practices that send these to a collection agency to harass the individual until either the funds are paid or they file a lawsuit and a judgement is made to garnish their wages and/or accounts? I would be very surprised if your practice was unlike all the others. You seem to have placed yourself on a pedestal, thinking you have found the ultimate solution for providers and patients alike when in reality, you have only effectively closed your doors to Medicare patients or left them with a bill that will be difficult for them to pay. To say that private insurance has fewer rules is ridiculous when the majority of plans will specifically refer to portions of Medicare rules, more so every year. Insurance companies are becoming more consistent with each other all the time. Medicare isn’t any different than any other government agency. They can be sticklers for the rules, sometimes to excess. Is it wrong to tell patients they can report fraud? No! My private insurance tells me that too! Are they bullies? No! Do they have some bullies working for them? Probably, just like any other organization. To say that Medicare doesn’t go after administration, just the doctors, demonstrates your level of ignorance and self absorption. Medicare DOES in fact go after administrators too. There are more than just Physician billing codes when it comes to Medicare and administration has responsibilities that Medicare holds them accountable to. And who do you think Medicare holds accountable for ensuring physicians are doing what they are supposed to and following all applicable rules and regs–administrators. Many of them hold licenses that can be at risk also. It never ceases to amaze me, with the vast wealth of knowledge physicians have, still so often they are left with such a limiting narrow view. I believe this to be a failure of the method of their education. However, this method may be necessary in order for us to have the fine quality of medical physicians available to us today.

        • Pamela Wible MD says:

          Honestly I have never sent anyone to collections. I don’t even know how to do it. I have never closed my doors to any patient who wanted to see me (for lack of money or insurance reasons). Commercial insurance is less onerous than Medicare which requires so much hoop jumping that you would need to hire a staff to help. I have no staff and have direct relationships with my patients and easily submit their claims and get paid without hassle from other insurers. This has been my personal experience and I started out accepting Medicare as an insurance so I know how this works (and doesn’t work) from personal experience.

  9. John Miller says:

    I recently turned 65. I am one of those “old people” you love.The reality is we are a cranky, complaining, selfish lot who get more government benefits than any other group of people in America, and are still ungrateful. Ever see the Medicare brochures? Everyone is smiling, to the point that their faces are going to crack. You should ask to model for one of those brochures. You have the required duplicitous smile and all the sad, warped self righteousness of an old person. Oh, I can read between the lines, Ms Wible. I get you. Your love for the elderly and claim that you never turn the sick away is just a variation of “I love black people; never turned one away from my home.”
    But never invited one in, either.

    • Pamela Wible MD says:

      You are off target my friend. I have never turned anyone away for lack of money in 11 years. Furthermore, I was adopted by a black family as a teenager. And I’ve had several black people living with me—including a foster child. Crankiness and complaining and lashing out at others is a poor use of your time.

  10. AMANDA WEBER says:

    SOME PHYSICIAN DO COMMIT BILLING AND MEDICARE FRAUD. THEY SHOULD BE TURNED IN. YOU SEEM TO THINK THERE BETTER THEN OTHERS WHO HAVE TO OBEY RULES . THERE NOT. IN GENERAL THEY ARE WORSE. A GOOD PORTION OF THEM ARE NARCISTIC GAME PLAYING BASTARDS. FACE IT PAM LET THEM GO.ALL THEY WANT IS MONEY. WHAT HAPPENED TO THE OATH THEY TOOK. DID THEY FORGET IT. QUACKERYS GONE WILD.

  11. Robert G. Volkmann says:

    What a nightmare!

    Surely, we humans can figure out a better way ….

    This page is a great contribution to understanding of the existing situation.

  12. Mark Leeds says:

    Pamela,

    Is it correct that opting out of Medicare means that you have medicare numbers and have at some time applied to medicare and maintained status with them but have followed a specific procedure of sending Medicare a statement of opting out at certain time intervals and having all of your patients sign a document promising not to file a claim for your services?

    My situation is that I was a medicare provider but I have not filed a claim since 2007. Due to that time passing without me being active, I have fallen into a status that I do not fully understand. Medicare support has told me that I would have to fill out forms including CMS 855i, 588, 460 and 116. These are the documents that a new doctor would have to fill out to apply to for Medicare for the first time. I do have some old Medicare numbers and an NPI number. I apparently lack a PCAN number. Some diagnostic centers have angrily called me demanding that I get a PCAN number so they can bill.

    This brings me to my question. What about not participating at all in Medicare? I know a local doctor with whom I had a conversation about five years ago and he told me that he fully withdrew from Medicare and has no numbers and does not opt out because he is not at all associated with them. He treats addiction and his practice is full. This sounds great, but my concern is that I am getting letters from insurance companies telling me that soon they will not pay for my patients’ medications if I am not enrolled in Medicare. I have received many of these letters this year. I can imagine that patients may leave me no matter how much they love me if they have to pay full price for medication. Not everything is on the Walmart $4 list unfortunately.

    What do you think about opting out vs complete disassociation from Medicare? I am sorry if I have explained anything here incorrectly, I don’t know if I fully understand the topic myself.

    Thank you!

    Mark

    • Pamela Wible MD says:

      That’s an interesting point Mark. Complete dissociation may negate the need to “opt out” if you have never ever been associated with Medicare. However, residencies are billing Medicare on your behalf as a resident so if you trained in a US residency program presumably you have been associated with Medicare which means (just to be safe) you should complete the opt out process so you do not run afoul of Medicare rules and regs (like 150,000 pages or more).

      Regarding insurance not covering Rx that is interesting. I see Medicare patients (though I have opted out of Medicare) and insurance still covers my prescriptions and labs/tests ordered for past 12 years. Not sure what to say there. May need more info and we can discuss in person: http://www.idealmedicalcare.org/contact.php

      • James says:

        I just want to second the fact that Medicare patients (assuming you are on the original Medicare plan and not an advantage or HMO type plan) can get all prescriptions and labs covered (within the limits of Medicare and the Medicare Part D drug plan you have chosen). This is a common misunderstanding among doctors who have opted out of Medicare. I have had to educate two that I personally have gone to about this issue. As a patient on Medicare I have found Medicare to cover far more tests and at a higher rate (usually 100% on bloodwork) than private insurance companies that other people I know are on.

        On the issue of doctors not taking Medicare – it is complicated. I understand why doctors don’t take it, doctors should be paid more than $80-$100/hr (and that would be under the most ideal circumstances of 4 patients an hour at a net of $20-$25 per patient). On the other hand there are a lot of people in metropolitan areas of the country such as the San Francisco Bay Area where there are zero doctors, at least that I have found, who can afford to offer the type of sliding scale you seem to offer. The doctors who I see here that are cash only charge $280 and $400/hr and they are on the low side. I would be interested in seeing the cost and earnings estimates for an ideal medical care clinic in an urban area like San Francisco.

        • Pamela Wible MD says:

          Thanks James! Really appreciate your input. I do know that docs who charge say $15-75/month for access to all primary care services can do quite well (survive financially & emotionally) around the country. High cost of living and high rent districts make it a bit tougher though for sure.

  13. JK Oneal, DO says:

    I feel that I was a great doctor. I scheduled every new appointment an hour and usually took the whole time. I was idealistic, took every insurance, gave discount prices to those without insurance, did a lot of patient education and was scrupulously honest. I was beloved by my patients. I went out of business in December 2013, mainly because of lack of reimbursement. Medicare contributed more than anything to my closing my practice. They had errors in their database and no matter how many times I sent in new applications (in spite of working successfully with Medicare for many years), they continued to assert that I was no longer a participating provider and would not pay me for any of the patient visits from Medicare patients (a huge part of my practice). Yes, part of it was my poor business sense. I was always more concerned with patient care than money. I should have employed an outside expert to deal with the Medicare issue. Anyway, I couldn’t continue to pay my employees with the $44,000 that Medicare owed me and that I will never see.

    It was extremely demoralizing to close my beloved medical practice after over 15 years. I joined a group practice as a salaried physician which I hoped would be the answer. But I absolutely could not stand their “fast-food hamburger medicine” approach with more concern with money than patient care. I left them after 6 months. I haven’t seen patients since July 2014 and have tried to work online doing record review.

    I feel sad that I am no longer seeing patients. I LOVED patient care and LOVED my patients and I was a great physician. After reading on Dr. Wible’s site, I know now how common my problems and frustrations were. I don’t know that Medicare is much worse than the other insurers, but one can only stand to be beaten up and abused so much and finally that’s it. That’s why good doctors are getting out of medicine.

    • Pamela Wible MD says:

      I would love to help you practice medicine the way you always dreamed of. Call me 541-345-2437. I will help you. Do not give up your beloved profession to the criminals around us.

    • Nicole Bumgardner says:

      I am so sorry to hear this. Medicine has taken a turn from being a customer service approach to an industrialized approach. I was an administrator at a hospital/healthcare center for over 2 decades of my career. We were one of the first hospitals in the nation to institute the electronic medical record and then link it with several other hospitals, clinics and imaging centers to share specific information as appropriate in an attempt to improve continuity of care for our shared patients. While very effective in that attempt, while monitoring the impact on the patients and physicians and patient-physician relationship, I noticed that the patient visit had suddenly become much less personable. It appeared as if the Physician was “treating” or “paying more attention to” the computer screen than the patient. It made the patient feel awkward and not really listened to. Here we had this new electronic medical record that helped improve the continuity of care for our patients, would eventually improve safety, etc but we had a big problem identified that needed fixed quickly. We came up with a method of using a tablet to document so the physician was still facing patient AND voice operated transcription notes so most of the time the physician was actually telling the patient what his assessment was, repeating what he said, educating etc and it was being documented in the patient’s record at the same time. While this all worked, it took a lot of people a lot of time to get set up. We did it all before the requirements hit. I can’t imagine the pressure others must have felt with a timeline over their head. I’ve heard so many physicians say similar things as you. It’s just getting too difficult to maintain private practice anymore with all the rules and regs and changing face of medicine. I thrived in administration because I have my clinical license and a business degree. I imagine you would need to contract out your coding and billing if you don’t have a pretty good understanding of the process or a practice manager you can really trust to direct Coding, Billing & A/R. Had I not ended up working in hospital administration, I think that’s probably where I would have gravitated. It was an up and coming field at the time but most physicians didn’t see the need for it yet. Without having the foresight of the direction Medicare would take, it would have been hard for me to honestly “sell” the position well. ???? But…many of us knew the regulations were only going to grow in size and difficulty. It sounds like you are what I like to affectionately call an “antique” (nothing to do with age)–meaning you do things the old way–the right way. I’m sure your patients loved you and miss you very much. I hope you trained many youth to have your compassion. It is so very rare these days.

  14. John Aikman says:

    It began with a head injury that resulted in a 4 level cervical fusion, failed surgery just made this like anything I could believe could happen to a human being. I was diagnosed with .PTSD, and narrowing of the spinal cord, pinched nerves at the level of hardware. Dealing with being cut off of the meds that where my only line of sanity, because I choose to opt on the idea of additional surgery, or a permenant pain pump.I’m someone that stayed with my doctor for many years, I found myself being dismissed on every visit that made me crazy. I’ve now been dealing with what looks to be a lifetime of constant pain, and physical disabilities. 2 mo. Ago I started having chest, arm and stomach pain unrelenting, 6 ER visits, 7th I was beaten by surcurity and taken to jail. I went home in pain and dealing with the fact I know no one’s going to help me. I found myself 2 weeks later unable to breath in more pain than ever. With ER doc that treated me 2 weeks prior acting with the same dismissive attitude, decided to run blood work and I had 3 blood clots going to my lungs, infraction inside 2 of them. Told if I stop taking the thinner I would die. Although I’m through what was horrible attack at the worst stag, I’m not sure if I can continue guessing what is wrong. Without a doctor, and coughing up blood. I’d be happy with no more of this slow kill method that seems to being used why Medicare uses protocol to treated the wrong things and expecting someone to live in a horror of a daily life.

  15. Rebecca says:

    I am currently in a 5000 level health policy and law class. It was assigned that I argue against mandatory Medicare. Thank you for making my job so easy with this article.
    ((hugs))

  16. Donna Beebe says:

    Your principles are admirable but unfortunately they apply only to the fraction of “old people” in the US who live in your area. The elderly have no choice but to used Medicare, and even if I lived near enough to your practice I would not want to rely on your charitable disposition, I would go where my visit is covered by Medicare and my secondary insurance, since I must pay for them any way. There are many people, especially in this age group, who are too proud to access care they cannot pay for, whether or not you wouldn’t “turn them away”. And how many other doctors, who may agree with you in principle, are willing to write off the bills of their patients who have no option other than Medicare? As a recently retired critical care RN I cared for non paying patients the same as every other patient, but of course did not have to deal with the billing headaches. But I am well aware this was possible only because of the “evil big government” system that forces hospitals to not “turn away” those who cannot pay. As a healthcare consumer I am dismayed at the issues concerning Medicare but am trapped in the system. My Lyme literate provider is cash only because of these issues, and Medicare refused to cover even the ($1500+) lab work, other than the CBCand CMP. And secondary insurance refuses if Medicare refuses. But other than flying across the entire country to see you (the only physician I know of who turns no one away), what choice do I, or most of us, have?

    • Pamela Wible MD says:

      There are many, many docs who function like me all over the country. Examples:

      Priya Carden MD who just opened an office down the road from me writes: n to opt out. But I did and it was he best decision ever. I still have around 40-50% of my patients being Medicare age. I offer discounts and bartering. Without copayment and deductibles (and just being more available for patients) my patients tell me that it’s actually cheaper in terms of costs in $ and in time. They don’t end up in urgent cares or with unnecessary meds/imaging or treatments. They have a primary that can spend time with to talk about what they want in health and life rather than ending up dying in a hospital ER somewhere 3 years after they would have wished to die at home on palliative care but didn’t know who to turn to to help navigate the medical quagmire. And being able to see them at home makes a HUGE difference in knowing their health situation. My patients that are financially stable donate so that less financially fortunate patients can afford this care. It’s about building a community and it needs to start from the ground up-if doctors and patients don’t show that it could be done, who will? Contact Priya here: http://www.mapletreehealing.com

      Jennifer Zomnir MD in Texas sees everyone over 90 years old for FREE!! House calls and everything!!! https://www.idealmedicalcare.org/blog/i-work-from-10-to-3-i-dont-work-weekends-im-an-incredibly-happy-doctor-in-my-ideal-clinic/

      • Donna Beebe says:

        Well, as I said, it’s great for you and for your patients. Most of us are forced to pay Medicare and a secondary because we have no other choice. And it’s getting more and more difficult to find physicians who accept Medicare, particularly specialists. Maybe as part of your crusade you could publish a list of like-minded physicians across the country. Until there are others who think as well as actually practice as you do, most of us are trapped in the present system with no other options. And the more physicians that opt out of Medicare because of its problems, the fewer options we have.

  17. I agree whole-heartedly. If you would like to be treated with love and compassion, search out a physician who has opted-out of Medicare. Otherwise, you may be treated like a “Medicare patient” in a treadmill clinic. You are more than your insurance card!

  18. Linda Cooper says:

    Interesting about Medicare, which I have been “on” along with my Anthem Blue Cross as a supplement for a couple of years. Three points: 1. Since my delicious doctor moved to Idaho from California, I “inherited” a primary care physician who does stare into his computer during the visit. I tried another doctor, and he wore google glasses. Hum. 2. I do rely on a clinic at times in the Redding, California area. The clinic doesn’t accept Medicare, however, the clinic bills on my behalf, Medicare and my secondary. All I know is that I pay in advance for the visit, and receive a “mystery” check in the mail about a month later from the clinic. I’m wondering if that is a path other doctors could take. The physician/internist I see does not stare into his computer. It’s not ideal, because the clinic is not set up for primary care. 3. I am still on the search for a doctor in my Redding, California area. If anyone knows of a…

    And last, which ought to be first, my many thanks to Dr. Wible and all the other medical professionals who do care. I have had some wonderful doctors, it’s just that times have changed. In fact, the doctor who delivered my daughter forty years ago, left Carmel, California to be on staff at a hospital in Nevada. He had a sign up in his office that stated, “this office does not carry malpractice insurance.” He hadn’t been sued, he was just frustrated over the regulations and attitude.

  19. Medicare paid 1/3 of the cost of your residency slot so that you would be available to treat Medicare patients for the common good of American healthcare.

    *drops mic*

    • Pamela Wible MD says:

      Just because someone or something contributes to your education doesn’t mean you submit to a abuse.

    • Deanna Kunkel says:

      Don’t believe the false narrative. Hospitals use residents as slave labor, receive a great deal of money for having a residency program, and pay the residents right around minimum wage when you calculate out the hours. This for people who already have eight years of education. The hospital administration supports residency because it’s another revenue stream for them plain and simple. And no I’m not a doctor, I’m a Nurse Practitioner who received no Medicare funding for my education, I paid it all out of pocket for seven years of education to make less than the finance, regulatory and administrators in healthcare. Yet, you and others like you, begrudge the people actually taking care of you an appropriate wage for what they contribute to your wellbeing. No discussion ever about how overpaid, and unnecessary the layers upon layers of expensive bureaucracy in healthcare are. Those people you have no beef with.

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