Overdue payment

Witholding Medicare payments hurts patients

Last week, the federal government initiated a plan to recover money from about 1,400 doctors and health care workers nationwide who have defaulted on government-guaranteed student loans. Under the new system, the government will no longer reimburse the delinquent doctors for treating Medicare and Medicaid patients. Proponents hope that the financial pressure engendered by the tactic will force doctors to remit the balance due on their loans. While the plan may help recover debts, it likely will compromise the quality of health care for the 36 million Americans covered by the nation's public health care network. To ensure that Medicare clients' care does not deteriorate, the government should repeal the system and seek alternative methods of addressing those who default on student loans.

While the Hypocractic Oath generally obligates doctors to treat all patients seeking health care, Medicare patients still constitute an undesirable segment of the patient population for many doctors. Under the current financial system, doctors who treat Medicare patients must submit highly detailed descriptions of services to obtain reimbursement from the Medicare program. Chronically slow with refunds, the government forces many doctors and health care providers to subsist for months without payment - even then, the payments often fail to cover doctors' entire treatment expenses. Caregivers already have a financial incentive to perform a less-thorough examination of Medicare patients - the more tests they run, the larger their financial disadvantage.

The new system will compound the problem. The targeted doctors will have even less incentive to provide exacting care to the patients. The government should not lose sight of physicians' main purpose nor the goal of Medicare - to provide Americans with comprehensive health care. The new plan proves discordant with the purpose, potentially sacrificing the well-being of Medicare clients for financial reward.

Admittedly, the new protocol does constitute a last-ditch effort by the Health Resources and Services Administration - the body that oversees the federal loan program - to recover more than $107 million owed by defaulters nationally. Each of the caregivers targeted has been contacted for at least three years about his or her delinquency and has been reported to credit bureaus and the Internal Revenue Service. Government collectors have also reported the defaulters to the Justice Department for potential legal retaliation. Upon failing in these avenues of collection, however, the government, which secured the loans, still must repay the banks that issued the loans.

Despite the financial bite made by unpaid loans and the necessity to recover the money due, the government should not have adopted a plan that significantly jeopardizes the access of Medicare and Medicaid clients - people who often cannot afford insurance alternatives to high-quality care. Officials must re-examine the implications of the latest collection strategy and devise an alternative method that does not place the well-being of millions of Americans at risk.

01-22-98