Several years ago grandparents Dawnia and Ray Clements got a letter from their family doctor. It said the clinic to which they had gone for years would no longer take their Medicare. So they called another doctor they had seen before. That doctor, who wasn't taking new Medicare patients, agreed to take them on. But then a letter came from that clinic too. And the Clementses found themselves without a doctor.
Want to make the political hot air about health care real? Try being over 65 and doctor-less in Alaska.
America has a Medicare problem, but Alaska's problem is even worse. Medicare covers the disabled and people over 65. In Alaska, the program reimburses doctors about 63 cents on the dollar compared with private insurance, according to one recent study. Even if patients want to and can afford it, the rules don't allow them to make up the difference. The cost of providing medical care here is higher than Outside. So for doctors, who say their average reimbursement is really often less than half the cost of care, taking on older patients means eating the majority of the cost of their care. Doctors are opting out. As of June, only about a dozen primary care doctors in Anchorage would take new Medicare patients, and only two of those were in regular private practice. Now there are fewer.
What does all that mean for patients? Three years ago, for Dawnia Clements, it meant burning through the phone book.
"I made 63 phone calls out of the yellow pages and each time I was told, no, they would take no new Medicare patients," she said.
"How can they call themselves primary care if they don't take grandmas?"
If she really needed care, she was told, she should go to the emergency room. Then she got what she thought was the flu. She didn't think it was serious enough for an emergency visit.
"I thought it would just get better," she said, "but it didn't."
Back in the days when she had a doctor, she would have called for advice. But that wasn't an option. One morning she woke up and couldn't breathe. She ended up in the emergency room, and then in the office of a lung specialist. (Specialists are reimbursed by Medicare at a higher rate, so in Anchorage they are more likely to take Medicare patients.) She had pneumonia. In the end, Medicare paid far more for her care than the cost of a primary care visit. After that, a friend of a friend of Clements' daughter, who was a primary care doctor, agreed to take her on as a favor.
"She had a mother my age," Clements said.
I called the AARP Anchorage office to see what they were telling members about finding doctors. Pat Luby, the advocacy director, said he was telling them to visit nurse practitioners. He didn't know of any primary care doctors in Anchorage who were taking new Medicare patients. People can also go to the Anchorage Neighborhood Health Center.
Some relief is on the way. The new health care bill will give a small reimbursement bump to primary care doctors and will make one check-up a year free. Two clinics, one at Providence Alaska Medical Center and one being organized by cardiologist George Rhyneer, will come online in the next few years. Another provision in the health care bill allows the state to set up an account to give grants to doctors who take Medicare patients to help cover the deficit in the price of care.
"The state's not jumping up and down to want to contribute to that," Luby said.
I asked the Senate candidates for their ideas about the problem. Lisa Murkowski and Scott McAdams say they want to fix the doctor reimbursement problem and the underlying formula that creates the low reimbursements. Joe Miller has said he wants to eventually phase out Medicare as it has been run by the federal government. In an e-mail he said he likes the idea of a voucher-system and thinks seniors who can should be able to pay the difference for their care.
All of these solutions still require more money. None of the candidates got specific about where that would come from.
Judy Engelson, 66, has diabetes. She spent years without health insurance or medication before Medicare kicked in last year. She thought Medicare was going to be a relief. Instead it was a confusing, bureaucratic nightmare. She called Medicare and asked which doctors she could see. She received a list and called every number on it and couldn't get an appointment. Finally, she ended up at Anchorage Neighborhood Health, where she finally got 10 minutes with a doctor and a prescription.
"Our health care system sucks so bad that it makes, like, Hoover noises," she said.
Two senior clinics will help our problems in Anchorage, but they won't solve them. The number of Medicare-eligible people is expected to double by 2020. Maybe you aren't worried about all this because you're still under 65, but think about it: How many years until Dawnia Clements' story is yours?