The Anti-Doctor, Anti-Elderly Conspiracy

The recent balanced budget agreement included a revision to the Medicare program that would make the average person wonder which is worse: trusting federal bureaucrats to run a health care system, or the way the federal government goes about passing the laws that guide those bureaucrats?

For some years Medicare, the federal health insurance program for the elderly and many disabled Americans, has been systematically reducing the amount of money it reimburses physicians and hospitals for delivering medical care. The new budget agreement reduces those reimbursements even more.

As a result, physicians have increasingly limited the number of Medicare patients in their practices, and sometimes refuse to accept new Medicare patients. Displeased with these events, patients have occasionally proposed paying out of pocket for their care if their physicians would continue seeing them.

That's where the law gets murky. The Health Care Financing Administration (HCFA), which administers the Medicare program, contends that Medicare patients cannot contract privately with physicians, even though for years there was apparently no law against it.

In order to resolve the question, a group of patients filed suit against HCFA. In his 1992 decision in Stewart v. Sullivan, Federal Judge Nicholas Politan stated that he could find no statutory prohibition that would prevent Medicare patients from privately contracting with physicians.

Case settled? Are Americans once again free to do what the law does not expressly prohibit? Not exactly. While the courts may say physicians can contract privately with Medicare patients, HCFA never changed its position. Many physicians, nervous about upsetting the federal agency that provides a large portion of their income, are reluctant to challenge a bureaucracy that can make their lives miserable – and often does.

Why should government care if some senior is seeing a doctor and paying out of pocket for those services, you ask? I wonder myself. But it's part of government's natural lust for control, and real control must be seamless control. If physicians are dependent on the government dollars they get from Medicare, they will be willing to practice medicine the way the government says.

Canada recognized this principle when its federal government nationalized the country's health care system. Legislators knew that if people were permitted to opt out of the system by paying cash for what they wanted, it would eventually lead to a two-tier system in which people with money would get the best health care immediately, while people without money would be forced into waiting lines for second-rate care – much like Medicare recipients are beginning to experience in the United States.

Such a two-tiered system would go against the socialist quest for equality and control, so Canada made it illegal for anyone – not just seniors, as in the United States – to pay out of pocket for any service covered under the national health plan.

Even these restrictions didn't work. Canadians simply started coming across the border to the United States to get health care immediately, sending the bill back to the provinces (which the province of Ontario put a stop to about five years ago) or paying out of pocket.

Here in the United States, Senator Jon Kyl (R-AZ) wanted to put an end to this murky state of affairs that makes it unclear whether physicians are acting illegally by contracting privately with Medicare patients, so he introduced a provision to the budget legislation that specifically permitted physicians to privately contract with seniors on Medicare. At the last minute, a Democratic-sponsored provision was slipped into the legislation that would require physicians who privately contract with Medicare-eligible patients not to take any Medicare reimbursements for two years. This provision effectively destroyed the Kyl provision, since relatively few physicians would take such a pledge.

A few members of Congress have tried to put a positive spin on the legislation, but many others, including some of those most actively involved in the issue, were unaware of the change or its implications. They are considering a "technical corrections" bill to reintroduce the Kyl provision – and a little freedom to American medicine, at least where seniors are concerned.

The reason Canada's health care system hasn't imploded is that it has a safety valve for those who want or need care immediately – the United States. Medicare also needs a safety valve: the ability of seniors to go to whichever doctor they want and pay for services out of pocket. When the government pays the bills, as it does in Medicare, it will want control., but why should the government care if I am spending my own money when I go to the doctor – unless, of course, bureaucrats think my money really belongs to them.