Getting there won't be pretty. But for the first time since the passage of Medicare in the 1960s, the forces favoring action on health-care reform are stronger than the forces of cynicism and obstruction.
Feel free to be skeptical. Since Bill and Hillary Clinton's reform efforts foundered in 1994, predicting the death of any comparable venture has been the safest bet in Washington.
But this conclusion misses almost everything that has been happening. It's not just that the public (including business) is frustrated with the status quo. And it has little to do with the details that policy wonks are necessarily hashing over.
What matters is that members of Congress have quietly been preparing the ground for reform since the Democrats took over two years ago. And the competing interest groups seem more inclined to get what they can out of reform than to stop the enterprise altogether.
"Many people, just as they become eligible for Medicare, discover that the insurance rug has been pulled out from under them. Some doctors — often internists but also gastroenterologists, gynecologists, psychiatrists and other specialists — are no longer accepting Medicare, either because they have opted out of the insurance system or they are not accepting new patients with Medicare coverage. The doctors’ reasons: reimbursement rates are too low and paperwork too much of a hassle.
When shopping for a doctor, ask if he or she is enrolled with Medicare. If the answer is no, that doctor has opted out of the system. Those who are enrolled fall into two categories, participating and nonparticipating. The latter receive a lower reimbursement from Medicare, and the patient has to pick up more of the bill."
How do you find a doctor who accepts Medicare? The Web site www.medicare.gov provides a list of enrolled doctors. Other sources are state medical societies and local hospitals, most of which have online directories of doctors. But that’s no guarantee they will see new patients.Other options are also available. Roughly 18,000 walk-in, stand-alone urgent care centers in the United States are staffed with doctors who set simple fractures, take X-rays, do minor surgery, diagnose ailments and write prescriptions. By far the majority of these centers take Medicare.