This trend is the result of a bipartisan assault on both Medicare and Medicaid, social entitlement programs for the elderly and poor that were won through working-class struggles and the rising Black rights movement in the 1960s.

Through his Balanced Budget Act in 1997, for example, former president William Clinton projected slashing spending for Medicare by $115 billion by 2003. Cuts now total $200 billion, and President George Bush is projecting further spending reductions. Medicare currently covers 40 million people, and the number of beneficiaries is expected to double by 2030.

Medicare cut payments to doctors by 5.4 percent this year. According to a March 17 New York Times article, "The government estimates that under current law, the fees paid for each medical service will be reduced in each of the next three years, for a total decrease of 17 percent from 2002 to 2005."

The American Academy of Family Physicians reports that 17 percent of family doctors are not taking new Medicare patients. According to Martha McSteen, president of the National Committee to Preserve Social Security and Medicare, "Many of our members across the country have told us that they are having difficulty finding a physician who accepts Medicare." A number of them are now seeking care among those involved in doctor-training programs.

The Times article interviewed a number of doctors around the country who are shunning new Medicare patients. "At current payment rates," noted Dr. Paul Buehrens, medical director of a clinic in Kirkland, Washington, that has specialized training in geriatrics, "Medicare is almost charity care."

Dr. Baretta Casey, 48, a family physician in rural Pikeville, Kentucky, commented, "For the last five years, I've watched my income go down and my expenses go up. About 60 percent of my practice is Medicare patients. I decided not to take any more Medicare patients in January, when the reimbursement rate was cut." She added that many private insurers base their payment rates on the amount reimbursed by Medicare.

Health maintenance organizations (HMOs), which began dropping Medicare patients from their coverage four years ago, have denied coverage to a total of 2.2 million people so far. Many elderly people have sought HMO coverage because Medicare provides no benefits for purchasing prescription drugs. As recently as three years ago, 70 percent of HMOs charged no monthly fee for Medicare plans. Today, the majority of Medicare patients who retain HMO coverage are being charged. One company in southern Ohio charges around $100 a month.

Dr. Abraham Rogozinski, 47, an orthopedic surgeon in Jacksonville, Florida, decided last year not to operate on Medicare patients or see them in his office, including a woman whose knee he replaced 10 years ago. At 68, she wants him to perform the same necessary operation on her other knee.

Dr. Robert Hogue, 51, president-elect of the Texas Academy of Family Physicians, told the Times that not only does he not take any new Medicare patients; "in fact, I don't take any new patients over the age of 60 because they will be on Medicare in the next five years."  
 
Blacks, Latinos get inferior care
In another development, a study released on March 20 by the Institute of Medicine documents the fact that racial and ethnic minorities in the United States receive lower quality health care than whites, even when their insurance and income are the same.

"The differences are pervasive," commented Martha Hill, director of the Center for Nursing Research at John Hopkins University School of Nursing, who helped compile the study. "It cuts across all conditions of health and across the entire country, and we think this is a very serious moral issue."

After reviewing more than 100 studies conducted over the past decade, the report's authors concluded that the disparities contribute to higher death rates among members of oppressed nationalities from cancer, heart disease, diabetes, and HIV infection.

"Members of minorities were less likely to be given appropriate medications for heart disease, or to undergo bypass surgery, and are less likely to receive kidney dialysis or transplants than whites," reported the March 21 Times. "But members of minorities are more likely to receive certain less desirable procedures." A study of Medicare beneficiaries, for instance, found that Blacks were 3.6 times as likely as whites to have their lower limbs amputated as a result of diabetes.  
 
 
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