Starting a national dialogue about Medicare's future

AMA Leader Commentary. By J. Edward Hill, MD. Dec. 2, 2002.

AMA LEADER COMMENTARY

A few words about current events in medical practice

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A message to all physicians from J. Edward Hill, MD, chair of the AMA Board of Trustees.

Recently, I participated in a Health Sector Assembly on Medicare that brought back my own experiences in Medicare's early years -- and my hopes and fears for the program. In 1967, I set up practice in rural Mississippi, in a town of about 3,000 people. (Now remember, 1967 was one of the first full years of Medicare.)

The big thing physicians noticed back then was that the number of patients they saw multiplied. Once they had their own Medicare cards in their hands, patients seemed to come out of the woodwork!

And our reception rooms became lively social centers, where they met their friends and neighbors.

And what we found in these patients! Malignant hypertension. Fulminant diabetes and renal failure. Cancers that had become very advanced. We found five cases of renal cell carcinomas in patients who lived on one street in that tiny town. Most physicians see only one or two cases of renal cell cancer their whole career. Five cases -- on one street with just 14 families! All because no one had sought out a doctor's care before. Because none of those elderly patients could afford it -- before Medicare.

It took about 10 years before the number of cases dwindled down into controlled numbers -- when we were able to control their hypertension, their diabetes. Women who hadn't known before what a Pap test was got one each year, so that cervical cancers became few and far between.

I often tell my residents that one of the most remarkable things about Medicare in its early years was how the claims were handled. My wife would sit at our kitchen table every evening, filling out the Medicare forms -- they were all hard copy then, no computer forms. And after three or so months, we'd get a check -- for the exact amount of the claim we had made. The exact amount! How often does that happen nowadays? [...]