Who Gets Care?

As I have written, it is likely more and more health care providers – particularly physicians – will further limit the number of Medicare and Medicaid (Medi-Cal in California) patients they treat.

The latest manifestation of that reality is an announcement by the Mayo Clinic that reports it “will ‘prioritize’ patients with private insurance over Medicare and Medicaid beneficiaries if the patients have similar conditions and seek care at the same time.”

So you may say, “How dare they?” But that ignores the reality that both Medicare and Medicaid pay much less than other insurances. In fact, government payments usually pay less than the cost of providing the care. If you are a health care provider with a high percentage of Medicare and Medicaid patients, you are on a path to financial ruin. 

When I visited Mayo Clinic in Rochester, Minn., last April as part of the process of NorthBay Healthcare becoming a member of the Mayo Clinic Care Network, each morning I was struck by the multitude of older patients, many in wheelchairs, descending upon the main entrance. I wondered how they manage to provide such great care to so many Medicare patients. Obviously the care is provided, but at a risk to the continuing viability of the most trusted name in American health care.

NorthBay Healthcare provides care to an even higher percentage of Medicare and Medi-Cal patients than does Mayo Clinic. We understand why it is prioritizing the patients they treat. But it is not something we have contemplated doing. However, the losses we incur in caring for Medicare and Medi-Cal patients must be offset by what we charge patients covered by commercial insurance plans. 

So-called “cost shifting” may not continue to work in the future. An often discussed single-payer system, a new but imprudent entitlement several candidates in next year’s gubernatorial contest are promising, would simply accelerate the move by health care providers to be selective in choosing who gets care. 

Mayo Clinic is in the forefront of developments in health care, so its decision to prioritize who they treat on the basis of economics is likely to become a trend.