When I’m 64

The Doctor, by Sir Luke Fildes (1891)

Image via Wikipedia

“Will you still see me next year?”

Her question threw me, as I thought the visit had gone well. She’s been my patient for the past four years. She originally came to me when her earlier physician decided to join a concierge practice. His new medical practice doesn’t take insurance and patients pay cash if they want to stay with that doctor—a lot of cash. Very similar to taking your dog to the vet, except vets have also started to accept pet insurance. The concierge practice offers 24–hour access to the physician. What my patient couldn’t understand is since they never returned her calls before why would they start now?

She’s also on a limited income after her retirement and generally healthy. Being pragmatic, she believes that since she always paid her health premiums on time, her insurer should pay for her care. She exercises daily, takes few medications and maintains the same lean weight she was in high school. She comes in twice a year to keep tabs on her cholesterol and to find out what else she can do to stay healthy.

She’s a very fit 64 year–old and as luck would have it turns 65 at the end of December. For her, the biggest change was going on Medicare as her primary insurance. But this was also the source of her question.

“Many of my friends can’t find a physician that takes Medicare,” she explained.

So there it was. After four years, she’s concerned that by switching to Medicare insurance I would literally show her the door. Despite the oath we take as physicians, some physicians now forsake their obligation to take care of patients based solely on the patient’s ability to pay. But in fairness, it’s not all based on greed. Each year it seems the government threatens to cut reimbursement to physicians. It’s only last–minute political maneuvers that prevent this from occurring. Now, many physicians feel their luck may run out and with the escalating costs of maintaining an office—such as paying their staff a decent wage—many physicians simply walk away from taking care of Medicare patients.

Despite the new Affordable Care Act, Medicare patients stay at risk for finding, and keeping a physician during the years they need them most. They can always go to urgent care centers, or the emergency room, or have their care from a hospitalist if admitted to the hospital. But having a physician that has known them for years, knows what they’ve been through and treats them like family is now at risk.

Her original question also made me think of the song by the Beatles, “When I’m 64.” Some of the lyrics—will you still need me / will you still feed me / when I’m 64—now seem prescient. Sadly, age now matters in health care and probably not in ways the medical profession ever intended.

About Steve P. Sanders

A general internist writing and sharing ideas and art.

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