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On July 30, 1965, President Lyndon B. Johnson signed into law a bill that revolutionized the practice of medicine in the United States.

The bill created Medicare and Medicaid, the federally run health insurance programs designed to provide health care coverage for the poor, and seniors 65 and older.��Prior to Medicare, it was virtually impossible for people in this age group to get private health insurance coverage.

Medicaid was developed to provide care for children, the poor, and the disabled, and those needing long-term care.

No other health insurance program has done more to dramatically change the way medicine is practiced. To this day, the main principles of Medicare coverage make it almost impossible to remember medicine without it: universal acceptance at age 65, no pre-existing condition exclusions, set premiums, regulated costs.

These concepts helped build the basis of the Affordable Care Act passed 45 years later.

But ask anyone who has newly obtained Medicare, and they will tell you that finding a doctor open to new patients with their insurance is not easy.

State House Speaker��Joseph Souki announced at the opening of the 2016 Legislature that he is that would require physicians practicing in Hawaii to serve Medicare patients. Would HB 1740 ever pass? Should it?

According to the U..S. Centers for Disease Control and Prevention, as of 2013 Hawaii had the of office-based physicians accepting new Medicare patients at 75.5 percent. Meanwhile, there was a 30 percent increase in Hawaii’s Medicare enrollment from 2010 to 2012.

Should the state mandate that all providers take patients with Medicare, traditionally thought of as a lower-paying insurer, or lose their license? Wouldn’t that make our doctor shortage significantly worse?

Perhaps there is another way to improve access for Medicare beneficiaries.

Maybe the answer lies at the heart of the local construction industry. Currently, for any new housing development or construction project, developers are mandated to have a certain percentage of the building be considered “affordable housing” in order to take advantage of certain tax credits and/or land that is designated for these purposes.

Another option is to provide a certain amount of funding for the Housing Authority to use at its��discretion to help pay for either maintenance of current housing, or construction of new housing. Essentially, in order to be given the chance to build luxury condominiums, developers are mandated to contribute in some fashion financially for the greater good of society in the hopes of funding housing for the less fortunate.

Allow those who choose not to take Medicare to keep their license to practice. But not without a yearly monetary contribution for the greater good of those carrying the very insurance coverage these doctors won’t accept.

What if those doctors who choose not to take Medicare patients are mandated to do the same?

A fixed contribution into a state fund for community-run health centers might just increase the centers’ bottom line, and allow for the hiring of additional doctors to see patients in need.��Doctors who accept at least an established minimum of Medicare patients would be exempt.

The payment amount might be enough to incentivize some doctors to open their practices to Medicare patients. It also might provide a pool of money to be used to support the care of these patients elsewhere.

As a member of a non-profit health center, my practice and those of my colleagues have always been open to patients with Medicare insurance. When I have a patient who reaches age 65 come into the office, there is no difference in the medical care we provide just because they are now receiving federally run insurance benefits.

That is not always the case elsewhere. Participation in Medicare is voluntary, and brings with it a lot of additional paperwork, guidelines, regulations and requirements.

Since I have always practiced in this environment, and work for a bigger health system, I haven’t been subjected to all of this on my own.�� But for my private practice colleagues, it may be more of a hassle than it’s worth.

I don’t see how mandating Medicare participation this will help with the doctor shortage in the islands. In fact, it will most likely make things worse.

Hawai‘i already has a severe lack of specialists, particularly on the neighbor islands. The current is projected to dramatically increase as the population ages. With our high cost of living, and rating as one of the , it will only worsen the situation if doctors are forced to see patients with certain insurances in the islands, but nowhere else in the United States.

It’s time to look at a non-participation fee. Allow those who choose not to take Medicare to keep their license to practice. But not without a yearly monetary contribution for the greater good of those carrying the very insurance coverage these doctors won’t accept.

It’s a win-win situation for everyone, especially��patients. We need to have a way to attract more providers to the state if we want good��quality medical care in Hawaii. Having a robust community health system, supplemented by additional revenue from our current physicians, will help to satisfy the needs of our seniors on Medicare.

We’re all hoping to be lucky enough to be alive at 65 and on Medicare ourselves someday, and we want to know that there will be doctors available to help take care of us, too.