As Medicare prepares to cut physician reimbursement by 10.6% on 15 July, physicians nationwide are preparing to no longer care for Medicare patients. It was reported last week that 42% of Texas physicians have already opted out of Medicare. Many more will surely follow if Congress does not block this major reimbursement cut.

Lowering the Medicare reimbursement of physicians so low that they cannot afford to care for Medicare patients has decreased the ability of many patients to access medical care. This is a very clever move by politicians and bureaucrats as it successfully creates another highly effective rationing tool: It prevents many elderly and disabled from even getting in line for care.

(As discussed on this blog previously, Medicaid patients have had similar problems.)

Rationing heath care is first achieved by progressively cutting the money paid to the principal providers of the health care, especially the physicians. We have seen this happen with both Medicaid and Medicare. With each cut, some physicians will elect to opt out of the health care plan, as they can no longer afford to provide the services needed by the patients in the plan, pay their employees, and keep their doors open for business.

A physician has many fixed costs associated with running a clinical practice. The major costs are employee salaries and benefits. Also, there is rent for the office space, costs for heating and cooling, electricity and water and sewage charges, costs for equipment and supplies, and insurance premiums. As an example, if overhead expenses average $40 per patient visit and the physician is reimbursed only $35 for the visit, the physician actually loses money for each Medicare patient seen.

The decreasing numbers of physicians participating in a health care plan make it more difficult for the patients in the plan to make appointments with physicians. In many towns and small cities there are now few physicians who will accept appointments with Medicaid or Medicare patients.

The poor, elderly, racial minorities, rural residents, and veterans are the first to experience the full brunt of the rationing. They can often not afford to seek other sources of health care.

There has been little courage on the part of Congress (and when it comes to state programs, legislators) to reverse the process. As long as voters do not understand that government is the problem and not the solution, health care quality will continue to deteriorate and costs will continue to rise. The politicians will promise changes with every election in order to gain ever more power and control over the very lives of the people.