If Congress passed a law so
sweeping as to be possibly the biggest infringement on economic
liberty this decade, would that be headline news? Apparently not.
Scant media attention has
been paid to the Balanced Budget Actís Medicare provision, which
blacklists doctors who provide medical treatment to
Medicare-eligible patients without billing Medicare. Beginning
January 1, doctors who treat seniors outside the Medicare system
will be required to sign an affidavit agreeing not to seek any
Medicare reimbursements for medical services for two years. Seniorsí
right to pay privately for medical services will essentially be
destroyed by this legislation, because few providers will be able
and/or willing to treat only seniors who do not use Medicare.
Medicare-eligible seniors were able to privately contract for
services if they were not participating in Medicare Part B, the
voluntary, but popular, supplemental medical insurance that covers
physician, outpatient, and other services. Under the new law, they
will be able to participate in Medicare Part B and privately
contract ó but the new law also makes it unlikely that they will be
able to find any willing providers. Catch-22?
Supporters of the new law
defend on two grounds the restriction on private contracting. First,
they argue it is a necessary protection against fraud and abuse of
the Medicare program.
In particular, the fear is
that physicians could "double-dip" by simultaneously receiving
payments from the Medicare program and from the patient. Their
concern may be valid, but unfortunately this prescription is more
dangerous than the ill it is designed to cure.
Even if a doctor were to
risk severe financial penalty and imprisonment by double-billing
Medicare and the patient, this illegal practice would create no
additional financial strain on the government system, compared to
Medicare payment alone.
Indeed, if the privately
contracted health service were covered under Medicare, the
government would be paying for the treatment no matter whether the
patient also pays for it or not.
Furthermore, an Explanation
of Medicare Benefits form is sent to each patient by the government
whenever Medicare pays a claim, making it easy for the patient who
suspects double-billing to report it to the government.
The restriction on private
health care for seniors is also defended in the name of consumer
protection. The argument is that unscrupulous doctors, if not
regulated, may overcharge patients. In other words, consumer choice
(as opposed to the financially unstable Medicare bureaucracy) will
lead to increased costs.
Nothing could be further
from the truth. Patient freedom to seek care outside the Medicare
system can only drive costs down and improve quality through
cost-conscious individual financial decisions. Patients who pay for
services out of their own pockets will make more considered and
thoughtful choices, weighing the need for treatment against costs.
A peculiar irony of this
Medicare restriction is that foreign seniors who travel to the U.S.
to obtain health care enjoy more freedom of choice than our own
seniors. Unlike Medicare-eligibles in the U.S., non-citizens may
privately contract for medical services without restriction (and
without being forced to pay into Medicare, either). Doctors who
would not dare contract with American seniors may treat without
restriction non-citizens paying privately. Even the much-maligned
British health care system is less restrictive than Medicare when it
comes to private contracting.
Can we then assume that the
Medicare Beneficiary Freedom to Contract Act sponsored by Senators
Jon Kyl (R-AZ) and Don Nickles (R-OK) and Congressman Bill Archer
(R-TX), which would remove the two-year exclusion from Medicare for
doctors who privately contract with Medicare-eligibles, will fix the
problem? Unfortunately, no.
The proposed "fix" would
expand private contracting, but contains a rule that allows it only
if privately contracted medical services are reported to the
Secretary of Health and Human Services. Seniors will be allowed to
purchase medical services on their own only if they sacrifice their
right to medical privacy. Seniors deserve better.
So far, none of this has
been deemed newsworthy by the American media. But does anyone really
doubt that readers and viewers would be interested in an attack on
the freedom of doctors and senior citizens? Reporters should hold
lawmakers accountable for behind-the-scenes actions designed to keep
seniors firmly in place in the Medicare system.
Naomi Lopez is a research
associate at the Institute for SocioEconomic Studies in White
Plains, New York.