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Why the AMA is wrong about Medicare

By Scott Holleran and Arthur Astorino, Jr., MD
web posted October 2, 2006

The American Medical Association (AMA) is now engaged in an irrational effort to prevent cuts in Medicare payments to doctors. The campaign, which recently included a "fly-in" where AMA members personally appealed to members of Congress in Washington D.C., is fundamentally flawed.

The AMA should take a proud, principled stand to protect the right of each doctor to determine his or her own fees and the right of each patient to choose a doctor. Instead, the Chicago-based organization is merely one more group begging for government favors. Pleading for political "pull" to share the spoils of socialized medicine‹the proper term for Medicare‹is a pathetic substitute for an articulate defense of the only economic system which protects individual rights: capitalism.

Doctors are quitting Medicare due to the low reimbursement rate and, primarily, the total absence of professional autonomy. Trying to comply with 130,000 pages of Medicare's regulations‹with the threat of criminal punishment for non-compliance‹is an administrative nightmare and a real danger to the doctor's livelihood.

Many doctors stay in Medicare due to a deep sense of commitment to their elderly patients‹people who are trapped in the Medicare system because private health insurance for those over age 65 was essentially rendered illegal when Medicare was instituted in 1965.

While seniors are forced into government-run health care, the nation's physicians and surgeons‹still the best in the world‹are robbed of their rights. Under Medicare's bureaucracy, everyone loses. The solution is freedom‹restored through rational, incremental reform.

Foremost, because Medicare is primarily a financial relationship between the patient and the government, not between the doctor and the government, it must be recognized that Medicare's proximity to the doctor should be laissez-faire; the terms of private practice should be under the doctor's, not the state's, control.

Medicare's patients have rights, too. Those who have paid Medicare taxes and fees for many years should be free to apply whatever Medicare pays toward the cost of services supplied by any physicians or surgeons. Doctor and patient alike should be free to think, decide and act on whatever treatment they view as best. They should be left alone to mutually determine payment for those services. Medicare should account for each recipient's reimbursement status‹and allow the patient to choose to pay out of pocket for the difference or find a physician who charges less.

This simple idea‹known as "balanced billing"‹restores to Medicare patients the right to pay the difference between what a chosen doctor charges and what the government reimburses. Under current restrictions, it is illegal for the doctor to accept a patient's payment for any amount over the government's approved reimbursement for a service covered by Medicare. The government also prohibits the patient from being reimbursed by Medicare if the patient chooses to privately contract for services with a doctor who does not accept Medicare.

Such prohibitions are wrong. Patients should be free to choose among doctors‹and be equally reimbursed by Medicare‹regardless of which doctors accept Medicare. That would be a real step toward quality healthcare, one that would encourage doctors to justify individual treatments and charges, not passively charge preset, one-size-fits-all rates, as is the current system. Free choice would likely lead to lower costs and fees for Medicare Part B coverage.

Medicare, founded on the false premise that health care is a right, enslaves those who actually practice medicine and distorts the market in ways that hurt everyone, and, while that is another topic, it underscores that Medicare is a complicated, morally bankrupt system that ought to be phased out. For now, the aforementioned basic steps toward reform protect the rights of doctor and patient and every other stakeholder in the medical profession.

The same cannot be said for the American Medical Association's campaign, which tacitly accepts government domination of health care and reduces the AMA to the status of a public union organized to exploit taxpayers and sacrifice members' self-interest. The AMA ought to fight for the doctor's right to practice medicine as he or she sees fit‹and for the patient's right to choose‹or get out of the way of those who do.

Scott Holleran (scott@afcm.org) is editorial director of Americans for Free Choice in Medicine (AFCM) (http://www.afcm.org) and Arthur Astorino, Jr., MD (art@afcm.org), a practicing physician, is the organization's founder and chairman. AFCM was established in 1993. © Copyright 2006 Americans for Free Choice in Medicine All rights reserved.


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