A few decades ago, when Medicare first became the law of the land, I remember reading that people over 65 required, on the average, three times as much health care as those of us younger and healthier. I used that number in many talks as part of my explanation of why health care for the elderly had its own set of parameters and imperatives. This was only an interesting bit of trivia until a few years ago, when I got my own Medicare card. Now I exemplify the point.
Over the years, at your behest, I had frequent involvement with the people who managed the Medicare program on all sorts of matters involving radiology and a lot of other things about Medicare and Medicaid, as well. Now, it was time for me to find out whether the program worked as well for patients as we had meant it to. In general, I am happy to observe that for this somewhat educated consumer, it works fairly well. It does not work well for me because I am knowledgeable about process. Rather, it works well from a patient viewpoint because it has been made user-friendly for patients.
You, as a provider, have to send my bill to the appropriate intermediary, whether or not you choose to accept assignment. The intermediary has to send a further bill on to my super-65 or Medicare-plus carrier. I note the difference between the amount billed, the Medicare allowable, and the amount paid and realize that some of the process I used to help work through has not improved significantly in the intervening years. On the other hand, given the games played by private health insurers and managed care schemes, in many ways, Medicare looks better than most of the others.
When the ACR extended Blue Cross and Blue Shield benefits to its employees, I asked to see a copy of the master coverage. Why did I want all that detail, I was asked. I had two reasons. One was that I wanted to know what was not covered or limited in scope. The other was that I was curious to learn how the plans covered radiology services. For garden variety doctor and hospital services, the coverage seemed adequate. If we had mental health problems, we would have had on-going quarrels. Normal pregnancies were generally covered. Abnormal ones presented coverage problems. A lot of things departing from tried and true paths were delayed or rejected. I saw this from the other end as you added isotope studies, ultrasound, and CT scanning, each of which required a structured effort to persuade Medicare to tell its intermediaries to cover the new imaging modalities. That was a common dilemma, in that for the first decades of Medicare, the carriers and intermediaries applied the same rules to Medicare as they applied to their own private health care coverage plans. Sometimes that was good. Often, it was bad. Radiologists seldom are insurance company medical directors. When I could get a favorable national policy, I preferred it. But we took any kind we could get. In part, this may be one reason for my cynical view of managed care plans as being good for either patients or physicians. I leave to you to ponder a circumstance in which a universal government-operated plan is demonstrably more advantageous than the melange of subsidized private ventures being touted as a successor.
But having delivered that sweeping generality, I do note that as consequences of reaching age 73 and the attentions of a good internist, I have had occasion to consult my friendly radiologist on more and more occasions in recent years. I have had DEXA scans, MRIs, needle thyroid biopsies, carotid Dopplers, renal ultrasound, and even a periodic chest radiograph. All of these procedures are performed in a timely manner in a well-equipped office by a friend whom I trust to know what he is doing.
I am pleased that the test results thus far have been mostly negative and I am not infested with any terminal condition, at least not yet. But I also am very taken by the key role that these procedures play in my internist’s management of my real and potential ailments. If you look at the list of procedures in the paragraph above, you can see that most of them are fairly new and are part of radiology. They are part of radiology because radiologists were key to their development and implementation. Keeping these modalities where they should be will not be easy. But I do hope you can manage to do for as much longer as I need your care. I need three times as much health care as youngsters do and I want to get it from friends.