I live in the state of Washington. I’m on Medicare. My primary-care physician tells me he loses money each time he sees me because what he gets from Medicare doesn’t cover his costs. He says that what he would get from Medicare would be almost two to three times as much if he were practicing in California. He also says the rates in Washington are lower because this state has a lower cost per patient. It seems like the doctors are in a Catch-22. The more he keeps costs down, the less money he gets from Medicare! Is this indeed the case?
It is true that the Medicare system needs to be adjusted with more attention devoted to prevention and more incentives for cutting down on unnecessary testing. Also, overall doctors’ Medicare fees have been cut in all states in a way that does make it difficult for many doctors to practice and maintain their lifestyles.
At the same time, I am not as sympathetic as you might expect to bellyaching doctors with their eyes on the bottom line. Medicine is supposed to be a passion, a calling. I’d rather hear about doctors who have difficulties saying goodbye to certain patients because they’ve grown attached to them. Being educated to study the human body and being able to dispense care and get paid for it is a privilege, and the best doctors realize this. I am sympathetic to the mountainous paperwork, strain and excess demands that practicing modern medicine in the United States today seems to entail, but I don’t think the current Medicare scales are going to drive any physicians into poverty.
I was recently diagnosed with polycythemia vera. I am told it is a rare disease, but you wouldn’t know it from the numbers of people who tell me they know someone who has it. My doctor told me he thinks the disease is more common than is reported, but he insists it is indeed rare.
Given the horrible increases in toxins and other pollution, do you think the changes in the environment might be causing an increase in polycythemia vera?
There is some reason to believe that p vera, a pre-leukemic condition (which may well not progress to leukemia), is on the increase, and that this rise is related to environmental toxins, particularly given the evidence that these conditions are more prevalent in industrial areas. Far more research needs to be done to confirm these trends, but their presence should be a matter of grave concern and research.
I am a disabled World War II vet. I suffered a sacroiliac strain in the service and now have arthritis in my neck, back and knees. Nothing helped until I began using a duragesic patch, which works much better than anything I tried previously. It is rather expensive and the veterans hospital does not have it since our President started cutting funding to the VA. I am concerned about how long I can afford this medication. Do you know of any other medications that might help? I am 83 years old, so I will probably be dead before any cure will be found, but I would appreciate any information that you might have.
Pain is a complex subject. Duragesic can be very effective for chronic pain, since each patch lasts for seventy-two hours, but it is a narcotic, which means it has addictive potential. It is not all that dissimilar in many respects from morphine or Percocet, and I am wary of long-term use without monitoring by a pain specialist. This is separate from your other point that funding is being cut to the VA system, a woeful prospect for such a dependable source of healthcare and research in the United States, and another sign of the Bush Administration’s callous disregard.