NORAD tracks Santa....

[06 Maestro]

ORIGINAL: NefariousKoel

Sometimes I think Doggie needs a creepy stalker.

Oh wait!  Nevermind!  All set.

[:D] Yea, he's got one.

[Emobama]

ORIGINAL: 06 Maestro

ORIGINAL: NefariousKoel

Sometimes I think Doggie needs a creepy stalker.

Oh wait!  Nevermind!  All set.

[:D] Yea, he's got one.

[06 Maestro]

ORIGINAL: pasternakski



I've always wanted to get face to face with somebody who begrudges disabled veterans the meager pittance they get so that I can kick 'im in the nuts so hard his eyes light up like a pinball machine and he goes into permanent tilt.

Ditto

One more time: anybody else wants to sh1t on my fellow veterans is welcome to pay me a visit. Anytime. Anywhere.

There are millions of men including non Vets (and quite a few women) that will happily back you up. Just PM me an advanced notice.

[06 Maestro]

Doggie

If you qualify for 900 per month from the VA, you got banged up pretty good. Years ago it was my honor to serve as a Service Officer for an American Legion post here in Nevada. You don't get very much unless you really, really deserve it.

Although I never saw any mention of it I strongly suspected you were a soldier or Marine-so now I know. I salute you and hope someday to shake your hand. If you ever make it to Las Vegas, PM me.

About the personal stalker; sort of funny, but pathetic also. It is written that a coward dies a thousand deaths. I assume that is an average amount. Perhaps with some it is twice that. Imagine the pain that those pukes must endure whenever they look themselves in the mirror. Perhaps the only time they can get their mind off of their misery is while kicking a big guy that they know won't hit them, because that is when they think they are being brave.

A happy and prosperous new year to all here, except the sniveling coward.

[rhondabrwn]

ORIGINAL: 06 Maestro

ORIGINAL: rhondabrwn

I've got health insurance through my school, but with a $1,000 deductible, $75 co-pay for doctor visits, and a 70% co-pay on the major medical. If I get hositalized for anything, it's going to be ruinous. They just raised our drug co-pay this year so I've quit taking all my drugs and am relying on diet and exercise to manage my diabetes. Fortunately for me, I'm so far away from a hospital that I don't worry about hospital bills - if anything serious happens, I'll be dead before an ambulance can get out here anyway. With luck, I might make it to 65 and medicare (3 more years) and I probably won't see a doctor again till then.

That is one lousy medical plan-better off just stashing cash-for after a bankruptcy.

Rhonda, I do admire the work you are doing. I am sort of familiar with the area there. A long time friend is a native of Gallup, NM. I have been on the Reservation multiple times (years ago)-a different world; some good and some bad, but quite backward. For better or worse, you chose that route yourself. No one made you go there.

True and I have no regrets about leaving business, becoming a teacher, and coming out to an isolated area. I quite deliberately wish to die before I can become a burden to my three grown children so this is a perfect place for me to accomplish that. I've had a good life.

I am addressing the idea that just because you have health insurance in this country it is not necessarily adequate to insure proper care. The IHS (Indian Health Service) provides free care to the Native Americans, but I hear complaints all the time about the quality of care being provided and it is really sad to have a student tell me that his parent's couldn't afford to expend the gasoline to drive to a clinic so they just stayed at home sick for two weeks. If I had this Health Insurance in Phoenix it wouldn't make any difference - high deductibles and co-pays discourage getting proper health care wherever you are living. When I came to Pinon the deductible was $350 and doctor visits were $35... in two years we've doubled our costs. This is also what is happening all across this country and this trend is going to continue and accelerate. If you are happy with what you have now, just hope that you will have it next year.

But I can attest that I survived for years with no health insurance (or care) at all until I hit the Emergency Room and got hospitalized twice with the Public picking up the tab because I was technically indigent. It was a public hospital so I was able to file a hardship claim and they waived over $50,000 in charges. I qualified despite working two jobs while going to school for my MA in Secondary Education. Both hospitalizations could have been prevented if I had been able to see a doctor before things went critical. People tend to discount just how much of this goes on and how much could be saved if everyone had access to timely medical care (yes, and that includes "illegal aliens" unless you want to let them die on the sidewalks in front of the Emergency Room).

I think it quite humorous that people are so intent on keeping "illegals" out of any health care reform option when we are all paying for their expensive Emergency Room medical care already. We should be demanding that they be included - it would save a lot of money if we could avoid the Emergency Room as their principal caregiver.

I guess it's like the blind men and the elephant - everyone sees what they want to see and everyone ends up with their own version of the "Obvious Truth". I'm sure everyone is quite sincere in their opinions based on their viewpoint and life experiences. I'm not surprised to see so much disagreement, though I am saddened by it because I can only see things getting worse.

I'm sorry to see this thread turn into the usual free for all with personal insults being thrown about. I guess that's why we can't have a political forum on Matrix to allow serious discussion of social and political issues. Perhaps if the Administrators would just step in and DELETE all posts with personal attacks as soon as they see them instead of just locking some interesting threads while leaving those offensive posts up for anyone to view. Better to deprive them of their audience and eliminate the imperative for offended parties to rebut the insults and keep the whole furball going for another round.

[darken92]

ORIGINAL: 06 Maestro

Try it, you'll like it-sounds like you will, anyway. Hey, what's twenty million people. And then after that, what's another 20 million people. I'm sure you won't mind paying for all those good folks.
If you can't understand the simple fact that 10's of millions of people appearing in a short period of time that are not suppose to be here can break the bank, you need to read a little bit more. Do you think I am making it up? You do not believe that illegal emigration cost billions every month? Are you unaware that there are hundreds of thousands of illegals in prison-because they are violent criminals?

One wonderful thing about the modern world is the ability to find information quite easily via the WWW. I suggest you try it.

Try it? What is it you wish me to try? Paying other peoples health Insurance? What has that got to do with people in the USA choosing to have, or not have a public health system. You seem to be on a rant and are not making sense.

Break the bank? Again you are ranting. The original concept was public and private health systems.

Do I think you are making it up? No, I think you are raving mad. All these emigrants coming into your country and breaking the law means you cant have a public health system? If you want to spend money on illegal emigrants thats you and your governments choice. It has not a thing to do with the decision to have a public health system.

It is a safe bet we are the same planet-and that is OK. What is really unfortunate is that their are people like you, that don't bother with facts, that are allowed to vote.

There is more than one reason for the increasing costs of medical insurance in America. Regardless of the system used, or what continent you live on, the types of problems that America is going through will eventually break your system. In the end, someone is paying the bills, and it is not Santa. Ooop's; I hope I did not tred on your parents turf, but you need to know the truth.

Same planet. Not menataly.This is a wierd type of rant. You just dont make sense and you, for some reason, dont want to say anythign about health care.

The types of problems the USA is going through? You need to make more sense. Australia has the best public health system in the world. We have one because it is the choices we make when we set up our system. Has nothing to do with you or the USA. Certainly has nothing to do with Santa.

The decision to have a public health system is a social choice dictated by the society you live in and your belief structure. Parents, Santa and all that other stuff are just the ranting of an angry person. What is it about the idea of having a public health system, about taking a social position of helping people that makes you so angry? You can just say you dont want one. You dont want to help your fellow American and you want your taxes to be spent else where, or lowered. While I dont agree with that position it makes much more sense then talking about Santa does.

[Chijohnaok2]

ORIGINAL: rhondabrwn

I think it quite humorous that people are so intent on keeping "illegals" out of any health care reform option when we are all paying for their expensive Emergency Room medical care already. We should be demanding that they be included - it would save a lot of money if we could avoid the Emergency Room as their principal caregiver.

I think that we can do one better than "keeping "illegals" out of any health care reform option". How about we simply keep them out of the country, period. No illegals here to get sick, means no health care expenses or facilities needed for them.

ORIGINAL: rhondabrwn
I'm sorry to see this thread turn into the usual free for all with personal insults being thrown about. I guess that's why we can't have a political forum on Matrix to allow serious discussion of social and political issues. Perhaps if the Administrators would just step in and DELETE all posts with personal attacks as soon as they see them instead of just locking some interesting threads while leaving those offensive posts up for anyone to view. Better to deprive them of their audience and eliminate the imperative for offended parties to rebut the insults and keep the whole furball going for another round.

I also would prefer that the discussions stayed on topic and avoided the personal insults. I respect Matrix's decision not to allow a political forum on their website, and understand the reasons why they have this policy.

I am not however in favor of Administrators deleting rmember's posts. Administrators are human, with opinions and viewpoints. I have no beef with any of the administrators here. However, having an admin being the arbiter of what is, and is not, an attack post, could potentially lead to trouble. An admin deleting some posts simply asks for the possibility (however remote) that an admin may become selective, deleting some attack posts, while leaving others. You could one day have an admin deleting posts that he disagrees with, while leaving those that he favors. It has been known to happen before.

[06 Maestro]

ORIGINAL: darken92
Try it? What is it you wish me to try? Paying other peoples health Insurance? What has that got to do with people in the USA choosing to have, or not have a public health system. You seem to be on a rant and are not making sense.

Break the bank? Again you are ranting. The original concept was public and private health systems.

So, this is what it sounds like talking to a brick. Perhaps English is not your first language, in which case you could have asked for a clarification-and I would have been happy to explain any point. In any event, your inability to connect the dots coupled with an arrogant attitude has grown boring. Revel in your prideful arrogance without me. I have better things to do.

[06 Maestro]

ORIGINAL: chijohnaok
I am not however in favor of Administrators deleting rmember's posts. Administrators are human, with opinions and viewpoints. I have no beef with any of the administrators here. However, having an admin being the arbiter of what is, and is not, an attack post, could potentially lead to trouble. An admin deleting some posts simply asks for the possibility (however remote) that an admin may become selective, deleting some attack posts, while leaving others. You could one day have an admin deleting posts that he disagrees with, while leaving those that he favors. It has been known to happen before.

You have a valid point about deleting posts. Although there could be some clear guidelines that would warrant that action.

What I really wish Matrix would do is to employ some type of IP tracking system so that sock puppets are automatically identified and banned. The banned persons posts could stay on the board for all posterity, but with a big label of "Banned" over the screen name. If there was such a system, I think that the vast majority of derailed and ugly discussions would disappear. There are characters that periodically appear here that are not part of any gaming community, but simply try to start a flame war for whatever reason they hold dear.

I have no idea how much such a system would cost, but it would be a big improvement around here. I'm sure in time such technology will be employed here. It has been used for some time on other public sites.

Matrix has reasonable rules, but are hard to follow when characters surface like they did in this thread.

[darken92]

ORIGINAL: 06 Maestro
So, this is what it sounds like talking to a brick. Perhaps English is not your first language, in which case you could have asked for a clarification-and I would have been happy to explain any point. In any event, your inability to connect the dots coupled with an arrogant attitude has grown boring. Revel in your prideful arrogance without me. I have better things to do.

So that is the limit of your argument? Your right, you most certainly have better things to do.

[Doggie]

Nothing humorous at all about keeping an illegal immigrant population the size of the United Kingdom out of the health care system. The United States could cope with providing emergency health care to 10 or 12 million resident foreigners but anybody who lives here knows that figure is nonsense, and it's not just emergency care that is being provided. I don't care how good your health care system is in Australia. Ship in fifty million foreigners who contribute nothing to the costs and it's going to go broke.

Nobody in the United States wants to deny emergency health care to people in need, but childbirth is not an emergency, especially when the patient has entered the United States illegally for the express purpose of gaming the social service system. The people of the United States have no moral or legal obligation to provide free medical care to the entire population of corrupt socialist governents in central America. We are also not obliged to provide them with educational and employment opportunities at the expense of our own population. If these people have been deprived of opportunity, then the responsibility for that lies with their own corrupt governments. Allowing them to shirk responsibility for their own failures by exporting their problems to the United States only serves to perpetuate the cycle of poverty and corruption.

As for creepy trolls, they provide the same entertainment value as circus sideshows. Some people will spare no effort in their attempt to disgrace themselves.

[Emobama]

ORIGINAL: pasternakski

I've always wanted to get face to face with somebody who begrudges disabled veterans the meager pittance they get so that I can kick 'im in the nuts so hard his eyes light up like a pinball machine and he goes into permanent tilt.

I have never heard a man say anything like that. As a matter of fact that kind of fighting is strictly against Man Law. I hope you are a lady.

[Emobama]

ORIGINAL: 06 Maestro

Doggie

If you qualify for 900 per month from the VA, you got banged up pretty good. Years ago it was my honor to serve as a Service Officer for an American Legion post here in Nevada. You don't get very much unless you really, really deserve it.

Although I never saw any mention of it I strongly suspected you were a soldier or Marine-so now I know. I salute you and hope someday to shake your hand. If you ever make it to Las Vegas, PM me.

About the personal stalker; sort of funny, but pathetic also. It is written that a coward dies a thousand deaths. I assume that is an average amount. Perhaps with some it is twice that. Imagine the pain that those pukes must endure whenever they look themselves in the mirror. Perhaps the only time they can get their mind off of their misery is while kicking a big guy that they know won't hit them, because that is when they think they are being brave.

A happy and prosperous new year to all here, except the sniveling coward.

You will not hear much about Doggie's service. All of his stories began with "I met the guy who" or "I used to hang out with the guys that". He was probably one of the truck drivers that would hang out with guys like me to feel like they were a soldier. Talk about stalkers and annoying. They were always kind of creepy and whenever you could actually use their help they were never around. If you had to load the truck up to take stuff out to the field they would look at you dumb as a cow and say they just drive the truck not load it.

Ask him about his service and the battle of the vending machine where he lost his leg. His MOS was probably 86 Profile, 96 Malingerer or 00 Capt. Sick Call.

The problem with people like Doggie is that they go into the service to come out with a medical discharge and to get that paycheck for the rest of their lives. You may think this noble but when I was in if there was some guy that was not carrying his weight the rest of us had to. When the duty sucked they were always on sick call.

The entitlement thinking that Doggie has contributes to some of the problems Doggie bitches about today. Because of people going into the service to get that medical disability check now they do not hire as many soldiers. They get Haliburton to do more and more because they do not have to pay some profile ridden desk jockey or cook $900 a month for the rest of their lives. It is sad that some people have that attitude. I was told many times never to get out without a medical discharge. I just never thought that was right. And looking at Doggie I can see how much the free hand out stunted his growth. He had no drive to ever take care of himself.

I am not saying that every soldier that gets a medical discharge does not deserve it, or more, but ask Doggie about his injury. Was he up front fighting the Viet Cong? Did he lose his leg because of a bad PLF?

I think you will be surprised. I know I was after hearing his talk about how brave and tough he was and watching him disparage other people.

That $900 a month could be going to a real hero. And it's not. [:(]

[Emobama]

ORIGINAL: Doggie

Allowing them to shirk responsibility for their own failures by exporting their problems to the United States only serves to perpetuate the cycle of poverty and corruption.

I could find no better words to describe you.

[Doggie]

So how does a real man get a name like "Igotmilk?" I really can't give it much thought without throwing up in my mouth a little. I do remember a period when nicknames were popular in the military, but "Igotmilk"?. For some reason I just can't imagine a real hero like yourself, no doubt a highly decorated Special forces type, going around with a Nom de guerre like that.

Maybe you would like to enlighten us as to the details of your distinguished military service? Not that anymone is interested, but as long as you are writing my fictional biography, you might as well make up a few lies about your own life. So how does an Army ranger with a license to kill and a steely, studly demeanor like you have demonstrated here end up with a name like "Igotmilk"?

I'll admit I was a cowardly army aviator. Never set foot at Fort Benning. I laid around Fort Huachuca just hoping someone would think enough of me to give me a name like "Igotmilk". It was a fantasy never realized. I just wasn't man enough to volunteer for duty as a cook or supply sergeant in an infantry regiment. Sucks to be me. I don't even have the guts to create a sock puppet account and stalk people on the internet. I do have the distinction of being the only guy here with his own fan club, so that must count for something.

[Emobama]

ORIGINAL: Doggie

So how does a real man get a name like "Igotmilk?" I really can't give it much thought without throwing up in my mouth a little. I do remember a period when nicknames were popular in the military, but "Igotmilk"?. For some reason I just can't imagine a real hero like yourself, no doubt a highly decorated Special forces type, going around with a Nom de guerre like that.

Maybe you would like to enlighten us as to the details of your distinguished military service? Not that anymone is interested, but as long as you are writing my fictional biography, you might as well make up a few lies about your own life. So how does an Army ranger with a license to kill and a steely, studly demeanor like you have demonstrated here end up with a name like "Igotmilk"?

I'll admit I was a cowardly army aviator. Never set foot at Fort Benning. I laid around Fort Huachuca just hoping someone would think enough of me to give me a name like "Igotmilk". It was a fantasy never realized. I just wasn't man enough to volunteer for duty as a cook or supply sergeant in an infantry regiment. Sucks to be me. I don't even have the guts to create a sock puppet account and stalk people on the internet. I do have the distinction of being the only guy here with his own fan club, so that must count for something.

Again with the attacks and distractions. The grand charade of smoke and mirrors. I think we went through this for pages where you never denied getting government aid yet tried to make it seem like you weren't. Now that is all out in the open.

So now lets look at the man behind the curtain again. You are saying you were an Army Aviator but not going as far as saying you were a pilot. I am not sure what that means, especially in light of the fact that you say you were a trucker. I am not sure how many pilots become truckers but I just assumed pilots were intelligent enough to get a job that was a little more mentally challenging than to read over sized white text on green signs. Intelligence and aptitude which would allow them to get a lucrative job in a field where it would not matter if they became tragically handicapped. You are barely scraping by with a $900 a month head start from Uncle Sam and even seem resentful that you are not getting a larger hand out.

You clearly feel you are competing with undocumented workers for public aid/welfare as well as for jobs. I am not going to shoot myself in the foot and say that a military trained pilot should really have better options than to compete on an equal footing with undocumented workers because some undocumented workers may be quite well educated and offering more to society than you seem to be. I certainly wonder in light of your other dance what the truth actually is.

An intelligent man like a pilot should still be able to work with his mind even if he was physically handicapped. I know that during the DOT COM bubble that workers really did not need to be that intelligent. Many a person got a good paying job just by simply having a pulse. With a clearance you would have been able to get a job without any experience.

You seem to have an iron in the fire of public assistance and may be a little biased about other people getting assistance. I am not sure if it would cut into the sweet deal you have going but I understand that you may feel threatened by anyone getting aid which you feel sole entitlement to.

[Doggie]

Hmmmm, here's your profile from another forum

Igotmilk


Location: Neverland Ranch

Webpage: www.pornking.us

Don't ask; don't tell? Not that there's anything wrong with that.

Oh wait, here's your military service record

Igotmilk
Race Tauren
Class Shaman
Level 47
Guild Unguilded
Server Nathrezim
Battlegroup Reckoning

Neverland ranch, huh? Yeah, that would be where real soldiers hang out.

[rhondabrwn]

ORIGINAL: chijohnaok

ORIGINAL: rhondabrwn

I think it quite humorous that people are so intent on keeping "illegals" out of any health care reform option when we are all paying for their expensive Emergency Room medical care already. We should be demanding that they be included - it would save a lot of money if we could avoid the Emergency Room as their principal caregiver.

I think that we can do one better than "keeping "illegals" out of any health care reform option". How about we simply keep them out of the country, period. No illegals here to get sick, means no health care expenses or facilities needed for them.

ORIGINAL: rhondabrwn
I'm sorry to see this thread turn into the usual free for all with personal insults being thrown about. I guess that's why we can't have a political forum on Matrix to allow serious discussion of social and political issues. Perhaps if the Administrators would just step in and DELETE all posts with personal attacks as soon as they see them instead of just locking some interesting threads while leaving those offensive posts up for anyone to view. Better to deprive them of their audience and eliminate the imperative for offended parties to rebut the insults and keep the whole furball going for another round.

I also would prefer that the discussions stayed on topic and avoided the personal insults. I respect Matrix's decision not to allow a political forum on their website, and understand the reasons why they have this policy.

I am not however in favor of Administrators deleting rmember's posts. Administrators are human, with opinions and viewpoints. I have no beef with any of the administrators here. However, having an admin being the arbiter of what is, and is not, an attack post, could potentially lead to trouble. An admin deleting some posts simply asks for the possibility (however remote) that an admin may become selective, deleting some attack posts, while leaving others. You could one day have an admin deleting posts that he disagrees with, while leaving those that he favors. It has been known to happen before.

You make a good point and we do have the magic button to IGNORE the idiots.

I agree on keeping illegal immigrants out of the country. The first step is to just crack down hard on anyone who employs them... no jobs... no incentive to come over the border. Another option might be a "guest worker" program, but that has it's own potential for abuse and the medical care problem remains. If a legal "guest worker" on a visa gets sick... what do you do with them? It's all a thorny issue and one that I don't see us solving anytime soon.

[Doggie]

Another option might be a "guest worker" program, but that has it's own potential for abuse and the medical care problem remains

You are old enough to know that's the way it used to be? Seasonal guest workers used to be issued work visas which allowed them to work in the United States. These visas were typically issued to migrant farm workers. They were allowed to work on farms during the harvest season after which they returned to Mexico. They had access to the same medical care as everyone else. As the employers (usually farmers) typically provided them with room and board, they were able to take most of their wages home. Migrant farm workers living in Mexico made enough working for 3 or 4 months to live year round in Mexico.

Immigration laws were enforceable. Central American guest workers were required to obtain a passport and work visa with a yearly expiration date. That is the same thing I had to do when I worked as a civilian in Europe. Drivers had to carry an international driver's licence issued in the home country, just like Americans living in Europe and Europeans visiting the United States.

It is only when politicians began pandering to the illegal alien vote that the problem got out of hand,.

[Chijohnaok2]

ORIGINAL: JW

ORIGINAL: Andrew Williams

Circling back to the expanded pool of people who will be joining Medicare (and whose procedures are reimbursed by the government at less than cost), doctors and hospitals will find themselves with an ever growing number of patients for whom they are getting less than cost for each procedure. The doctors/hospitals will either have to pass on the cost to private insurance carriers, or decide not to accept Medicare patients, or simply decide to retire/get out of the business. More patients will be seeing doctors & visiting hospitals, but will find less doctors & hospitals to visit. Therefore, most patients may find themselves standing in waiting lines and waiting for surguries & procedures that they do not have to wait for now.

Please send a link to where I can get a crystal ball like yours... any tips for this weekends races?

I think he is right about that part of it. A link for some information.

http://www.usatoday.com/news/health/200 ... clude=Juno

I know docs who are older and going to retire before all this starts hitting, and others who are not going to take medicare patients because they will lose money on them.

Medicare is a big problem in the US. It is an important service, yet it is financially unstable and is going to start running huge deficits. Adding more patients while decreasing reimbursements is not going to help things.

And remember, from earlier, I generally support a single payer system for the US. I'm on the far left side of the issue. But the cost issues will have to be addressed.

Another example.........

http://www.bloomberg.com/apps/news?pid= ... oYSI84VdL0

Mayo Clinic in Arizona to Stop Treating Some Medicare Patients


By David Olmos

Dec. 31 (Bloomberg) -- The Mayo Clinic, praised by President Barack Obama as a national model for efficient health care, will stop accepting Medicare patients as of tomorrow at one of its primary-care clinics in Arizona, saying the U.S. government pays too little.

More than 3,000 patients eligible for Medicare, the government’s largest health-insurance program, will be forced to pay cash if they want to continue seeing their doctors at a Mayo family clinic in Glendale, northwest of Phoenix, said Michael Yardley, a Mayo spokesman. The decision, which Yardley called a two-year pilot project, won’t affect other Mayo facilities in Arizona, Florida and Minnesota.

Obama in June cited the nonprofit Rochester, Minnesota-based Mayo Clinic and the Cleveland Clinic in Ohio for offering “the highest quality care at costs well below the national norm.” Mayo’s move to drop Medicare patients may be copied by family doctors, some of whom have stopped accepting new patients from the program, said Lori Heim, president of the American Academy of Family Physicians, in a telephone interview yesterday.

“Many physicians have said, ‘I simply cannot afford to keep taking care of Medicare patients,’” said Heim, a family doctor who practices in Laurinburg, North Carolina. “If you truly know your business costs and you are losing money, it doesn’t make sense to do more of it.”

Medicare Loss

The Mayo organization had 3,700 staff physicians and scientists and treated 526,000 patients in 2008. It lost $840 million last year on Medicare, the government’s health program for the disabled and those 65 and older, Mayo spokeswoman Lynn Closway said.

Mayo’s hospital and four clinics in Arizona, including the Glendale facility, lost $120 million on Medicare patients last year, Yardley said. The program’s payments cover about 50 percent of the cost of treating elderly primary-care patients at the Glendale clinic, he said.

“We firmly believe that Medicare needs to be reformed,” Yardley said in a Dec. 23 e-mail. “It has been true for many years that Medicare payments no longer reflect the increasing cost of providing services for patients.”

Mayo will assess the financial effect of the decision in Glendale to drop Medicare patients “to see if it could have implications beyond Arizona,” he said.

Nationwide, doctors made about 20 percent less for treating Medicare patients than they did caring for privately insured patients in 2007, a payment gap that has remained stable during the last decade, according to a March report by the Medicare Payment Advisory Commission, a panel that advises Congress on Medicare issues. Congress last week postponed for two months a 21.5 percent cut in Medicare reimbursements for doctors.

National Participation

Medicare covered an estimated 45 million Americans at the end of 2008, according to the Centers for Medicare & Medicaid Services, the agency in charge of the programs. While 92 percent of U.S. family doctors participate in Medicare, only 73 percent of those are accepting new patients under the program, said Heim of the national physicians’ group, citing surveys by the Leawood, Kansas-based organization.

Greater access to primary care is a goal of the broad overhaul supported by Obama that would provide health insurance to about 31 million more Americans. More family doctors are needed to help reduce medical costs by encouraging prevention and early treatment, Obama said in a June 15 speech to the American Medical Association meeting in Chicago.

Reid Cherlin, a White House spokesman for health care, declined comment on Mayo’s decision to drop Medicare primary care patients at its Glendale clinic.

Medicare Costs

Mayo’s Medicare losses in Arizona may be worse than typical for doctors across the U.S., Heim said. Physician costs vary depending on business expenses such as office rent and payroll. “It is very common that we hear that Medicare is below costs or barely covering costs,” Heim said.

Mayo will continue to accept Medicare as payment for laboratory services and specialist care such as cardiology and neurology, Yardley said.

Robert Berenson, a fellow at the Urban Institute’s Health Policy Center in Washington, D.C., said physicians’ claims of inadequate reimbursement are overstated. Rather, the program faces a lack of medical providers because not enough new doctors are becoming family doctors, internists and pediatricians who oversee patients’ primary care.

“Some primary care doctors don’t have to see Medicare patients because there is an unlimited demand for their services,” Berenson said. When patients with private insurance can be treated at 50 percent to 100 percent higher fees, “then Medicare does indeed look like a poor payer,” he said.

Annual Costs

A Medicare patient who chooses to stay at Mayo’s Glendale clinic will pay about $1,500 a year for an annual physical and three other doctor visits, according to an October letter from the facility. Each patient also will be assessed a $250 annual administrative fee, according to the letter. Medicare patients at the Glendale clinic won’t be allowed to switch to a primary care doctor at another Mayo facility.

A few hundred of the clinic’s Medicare patients have decided to pay cash to continue seeing their primary care doctors, Yardley said. Mayo is helping other patients find new physicians who will accept Medicare.

“We’ve had many patients call us and express their unhappiness,” he said. “It’s not been a pleasant experience.”

Mayo’s decision may herald similar moves by other Phoenix- area doctors who cite inadequate Medicare fees as a reason to curtail treatment of the elderly, said John Rivers, chief executive of the Phoenix-based Arizona Hospital and Healthcare Association.

“We’ve got doctors who are saying we are not going to deal with Medicare patients in the hospital” because they consider the fees too low, Rivers said. “Or they are saying we are not going to take new ones in our practice.”

To contact the reporter on this story: David Olmos in San Francisco at dolmos@bloomberg.net

Last Updated: December 31, 2009 00:01 EST