Gone Fishing

It was early and the sun just creeping over the horizon. The air was cleansed by the rain the night before, the grass still wet. He walked bent down below the cedar tree and pulled on the large rock at its base, revealing its underside. There, tucked neatly in a slime-lined dirt corridor was a large nightcrawler, unaware of its predicament. He reached down to snatch his quarry as the worm thrashed to and fro between his digits, lubricating his grip with clear, oleaginous slime.

For more than two decades, internist Lee Antles has treated Medicare patients at his practice in Olympia, Wash. Last month, he started turning them away.

What pushed him over the edge was Congress's failure to end the looming threat—which no one expects to be carried through—of a 21% payment cut for doctors who participate in the seniors' insurance program. Last year, he and his wife, Margie, who manages the office, took home $55,000 before taxes, he said.

He changed hands with the creature and wiped his dominant hand on his trousers, then reached up to grasp the monofilament just short of the shiny iridescent hook. His fingers slid down the line to control the hook as he pondered the location to impale the juicy allurement. "Better to have the worm wiggle," he thought as the hook pierced the skin just proximal to the worm's lighter-colored citellum.

At Dr. Antles's practice in Olympia, Medicare pays him $95 for a visit that covers six organ systems. By comparison, Aetna Inc. pays $129 and Uniform Medical Plan, which covers state workers, pays $140. To bridge the patchy reimbursements, Margie Antles has taken out four loans and borrowed money from her parents.

The worm wriggled and slimed, its caudal portion curling back on the embedded metallic foreign body. The man grasped a second spot a bit further down the worm's length, curling its body so it could be impaled again. The folded portion of the worm was now firmly secured while the ends kept flipping to and fro as a half-red and half-white sphere was clipped a bit higher on the line.

For seniors, the tussle in Washington could make it more difficult to find a doctor, especially if they're switching doctors. Medicare pays physicians at a lower rate than private insurers, and they complain of too much paperwork.

Suddenly, with little hesitation, the line was cast and worm, hook and bobber flew effortlessly to land on the water's surface.

Silence.

Ostuni and other delegates are upset a Medicare payment formula was not a permanent part of the new health reform law. Because it was not in the law, the AMA now has to lobby Senate Republicans for another temporary payment fix to avert the scheduled cut.

The bobber sat motionless on the water's surface. A light fog hung just above the water. A damselfly landed on the bobber only briefly before it moved. A tiny movement at first, radiating ripples on the water's surface from the bobber's location. A pause. Then another tiny jiggle and more ripples. Suddenly, the bobber disappeared. The man gave a hefty jerk to the line, but sadly, line came easily. "Damn, too hard," he thought, and reeled in the line to find his nightcrawler gone.

Dr. Antles is considering quitting medicine and moving to Chicago, so his wife can return to a sales job that pays at least twice that much. "It just causes me such angst," he said, who would become a stay-at-home father to the couple's six-year-old daughter. "It leaves 1,000 Medicare patients. Where do they go?"

-Wes