However you slice it, the current political dogfight surrounding cuts to the federal Medicaid program—and efforts underway as I write to stop them—is both an economic and social problem.  Major newspapers including the Wall Street Journal and the New York Times have recently covered both facets of the debate in broad strokes.  And yesterday insideARM’s Cynthia Wilson’s “Tug-of-War” article engaged the issue from a receivables management perspective.

I’d like to push Ms. Wilson’s perspective a bit further.  As groups on each side of the Medicare reimbursement dispute begin to lay their cards on the table, some medical practitioners have raised the stakes in the game by suggesting that if the proposed payment cuts are not rescinded, they will be forced to turn away Medicare patients in order for their practices to remain financially viable.

Access to care is conventionally understood to be a social factor in discussions about the U.S. healthcare system.  But in the present context, more limited access to care for the nearly 40 million elderly Americans who rely on Medicare has grave economic consequences for healthcare creditors, patients, and ARM companies that collect delinquent medical receivables.

Mr. Smith’s local physician informs him that she will no longer see Medicare patients.  Mr. Smith then has to find a new doctor whose office happens to be 20 miles from his hometown.  Mr. Smith doesn’t drive.  His daughter takes him to the doctor, using leave time from her job.  Mr. Smith offers to pay for his daughter’s gasoline, at $4.19 per gallon in July… then at $4.37 per gallon in August… then…

They say time is money.  If you drive a car, you know all too well that gas is money.  For many elderly Americans on Medicare and with finite incomes, the social “annoyance” of having to travel farther to see a doctor quickly becomes a real dollars and cents problem that affects not only the patient, but potentially families, friends, and communities.

Mr. Smith now spends part of his household budget on gas.  His daughter now spends part of her household budget on added car maintenance.  Neither person has grown his or her income, but they might be growing their debt loads.  The social turned economic.  But don’t worry; it won’t stay an exclusively economic issue for long.  When Mr. Smith can’t pay a hospital bill next winter, and the past due notices and collection calls start coming, healthcare providers and collection agencies will quickly see just how ugly a newspaper feature on the social audacity of “squeezing” elderly Americans for delinquent medical bills can be.