A friend of mine recently opted out of Medicare. Let me explain to you what this means in case you don’t know. He doesn’t refuse Medicare patients, just Medicare. This was for him, like all other physicians I know, the most liberating act of their medical practice. He shared this story with me.
One particular Medicare patient my friend the ear, nose and throat surgeon had taken care of was very worried that he would not be able to get in to see his favorite doctor. This patient has a chronic condition that requires periodic nasal procedures done in the office. He doesn’t have a lot of money and will need ongoing care for the rest of his life. He made an appointment as usual and at the end of his procedure acknowledged the physician’s decision to opt out and asked him if there was someone else he could see.
My friend looked at him and said, “what do you mean? Don’t you want to come here and see me?” The patient told him that he didn’t think he could afford it, paying out of pocket large amounts for his visits and procedures. ”Bring me a Vente Starbucks Cafe Americano when you come in and we’ll call it even.”
Before the full impact of this story can be appreciated some background information is needed for a proper context. Think of the Medicare Ponzi scheme as the Titanic. The now retired senator from Texas, Phil Gramm, used this analogy regularly. Think of it as the Titanic with a twist, though: some of you know it is going to hit the iceberg before it does. Your warnings are met with derision and you are marginalized and labeled a “radical.” Those of you (patients and physicians) who don’t wish to sink in the icy water get in the lifeboats (opt out). The politicians and mainstream name-callers begin rearranging the deck chairs and claim that Medicare has been reformed (this was Gramm’s famous quote: ”reforming Medicare is like rearranging the deck chairs on the Titanic”). The denial and dishonesty on the ship just as in the entitlement program, ultimately result in needless suffering and loss of life.
Note that my surgeon friend and the patient are the only two parties in the coffee- for -nose -surgery exchange. No third party is present to deny payment “because this procedure is no longer on the approved list,” or something like that. Medicare isn’t raiding this physician’s office because he coded the claim improperly. The physician is happy to see this patient and is looking forward to his coffee once he sees this patient on his schedule that day. The patient doesn’t harbor that entitled attitude that frustrates so many in the medical profession. He knows that the doctor will be thrilled to see him. Good coffee has a way of bonding folks, you know. The taxpayer is happy because no money is expropriated from him or her to pay for this office visit/procedure. Our children and grandchildren are spared additional debt, as well.
As the bankrupt program nears its end, rationing will be the order of the day. Procedures and medications will be denied. This rationing may take the form of payment amounts that are so low to physicians that they no longer perform certain procedures at all, as the payment very likely will be below their cost of delivery. The Medicare bureaucrats and politicians can say that they are continuing to pay for total hip replacements, for instance, but the greedy doctors simply won’t do them anymore for $100. This has been the approach by the Medicare bureaucracy for about ten years and I predict will become much more intense soon. As more and more physicians opt out of the scheme, more and more patients will follow them and do so gladly, as that will be the only way for the elderly to receive care at all.
Medicare will end, one way or the other. Less people will lose their lives if we proceed in an orderly fashion to the life boats. Think of the practice of a physician who has opted out as a lifeboat. The physician who has opted out and has been labeled a “radical” by the mainstream lemmings, may be the only reason you get any medical care in the future. Time to get on board with these doctors and off of the big boat.
G. Keith Smith, M.D.
