Many physicians are no longer accepting Medicare. Some are continuing to see Medicare-covered patients but with the understanding that Medicare will not be involved in the payment of care rendered by the physician. Why would a doctor do this?
Risk: if a physician makes a mistake on a Medicare claim (no matter how innocent) he/she is eligible for a stay in a federal prison and bankrupting fines. The Medicare storm-troopers descend on his/her practice and rifle through all of the physician’s files and find all of the “mistakes” they could possibly need to put the physician in jail or bankruptcy.
Payment: payments to physicians for Medicare patients are often times below the costs incurred to see Medicare patients. Legal caps are placed on these payments and contrary to what many Medicare patients think, physicians can’t just bill them whatever they want. Secondary insurance is therefore a scam, as physicians can’t bill beyond the limits imposed by Medicare in the first place.
Oath: Some physicians (fewer and fewer, sadly) took their Hippocratic oath seriously. As physicians we are obligated to do what we think is in the best interest of the patient…..PERIOD. If a third party has a restrictive formulary or otherwise places obstacles preventing what is best for the patient, that represents an impossible dilemma for the physician and one many are increasingly unwilling to face.
Philosophy: Some physicians believe that Medicare money is stolen property. I, for instance, have no right to the income of my neighbor for an anesthetic that I provided to some guy for his knee replacement that my neighbor doesn’t even know. Many times physicians represent themselves as fiscal conservatives, wanting small government, but at the same time will lobby Congress’s gang of 535 for more money from Medicare!
Dedication: some physicians are dedicated to their patients….hard to believe, huh? This is why many are willing to turn to a method of payment known as “private contracting.” Medicare patients typically sign a waiver in which they acknowledge that no Medicare claim will be filed by either them or the physician and that payment will be made directly to the physician.
Private contracting will, I believe, become an increasingly common practice as Medicare’s bankruptcy becomes more apparent. Physician payments will be slashed again and again and the delays in payment will increase over time. Fewer and fewer services will be covered and in order for a Medicare patient to be seen in a timely manner (wow!…sounding kind of like the mess north of the border, huh?!) they will have to pay the physician directly or even go to a foreign country if this practice is made illegal.
I have mixed feelings about private contracting. I have done this to some degree, but see it as a way to prop up “the system” for a longer time than it would otherwise stand on its own. People that are sick or hurt need care, though. But the entitlement mentality among the Medicare population is very distressing. I don’t believe that any real changes to Medicare or abolishing this Ponzi scheme are likely until widespread shortages of physician services to this group of people emerge. Only the distress and the complaints of the Medicare population will result in the dissolution of this wealth transfer scheme.
I believe that this is coming and that there is hope for the wonders of the free market in medicine for the elderly once again. Ironically it will be the bankruptcy of Medicare that is the salvation of the health of the individuals that are held captive by this “program.”
G. Keith Smith, M.D.