Until I was twenty I was considered a scientific genius, but then my hereditary insanity kicked in, so I never got far as a physicist or computer software analyst. I have been disabled since 1982. In recent years, I have turned to writing, since mental illness is considered less of a handicap in the field of literature. Until October 12, 2002, I had written nothing for four months; I was too depressed to write. Now I am in danger of becoming manic, so I have decided to write about a depressing subject: Medicare.
Ours is the only advanced country that is free from the purported evils of "socialized medicine." This is because the affluent are unwilling to pay more taxes to benefit the poor and the lower middle class, and because the powerful special interests that greatly profit from the present situation are unwilling to surrender their unfair advantages. Of course, we do have Medicare for the elderly and the disabled, but it has long been government policy to save money by putting the screws on us patients.
In the year 2000, my shrink was permitted to charge us Medicare patients only $80 per 30-minute visit, of which we paid $41.51 and Medicare paid the rest. However, he has many wealthy patients who are over 65, and he complained that when they came to see him he got less than the cost of their limousine ride. The government does not require doctors to participate in Medicare, so my shrink quit the program. He said that he would have liked to continue to use Medicare for patients like me while soaking the rich ones, but Uncle Sam won't let him.
Is it fitting that the upper class should be required to rub shoulders in the waiting room with the hoi polloi? In any case, the government saves money since doctors are divided into two classes. In the first group are the ones who have good reputations and can therefore get wealthy older patients to pay more than the legal Medicare rate. The second group lacks good reputations and therefore can't attract the high-paying patients. Treatments provided by the upper class doctors cost the government nothing, and less affluent patients get inferior care. (Meanwhile, Medicare pays approximately 50% for mental health outpatient treatment but approximately 80% for non-psychiatric treatment.)
To be precise, the doctors who treat less affluent patients tend to be less skilled, and the government's policy intensifies this tendency. An excellent, altruistic doctor might well be willing to spend a fraction of his time treating poorer people as a public service, but he may lose a LOT of money if he participates in Medicare. If he chooses not to participate in Medicare, then when he treats elderly or disabled poorer people Medicare will contribute nothing toward the cost. Therefore poorer patients with Medicare probably won't be treated by this altruistic doctor.
I'm not affluent, but my income is higher than most disabled people. My Social Security disability check is based on the fact that I worked at fairly good jobs for some years, and I also receive a long-term disability check from the insurance company of my last employer. Furthermore, my mother is my landlord, charging me a small fraction of the going rate. I have not added up the cost of my drugs, but they are very expensive also, and Medicare doesn't cover them at all. I would like to see the law changed so that doctors could use Medicare for some patients and not for others, and so that Medicare and Medicaid would observe the principle of "parity," meaning that psychiatric outpatients should get the same benefits as those with other illnesses. On general principles, the present discrimination is hard to justify, and our society is supposed to be opposed to any unjustified discrimination. I intend to say more about parity in a future article.