- The Washington Times - Wednesday, January 25, 2012

Should people be allowed to leave Medicare? This is a real question, not a rhetorical one. Even though Medicare is said to be highly popular, indispensable and a great boon to American seniors, some people really want out.

It is not hard to understand why young people tend to like Ron Paul’s or Paul Ryan’s suggestion to let them provide for their own retirement needs. Many of them think Social Security and Medicare will be gone by the time they are eligible, no matter which party is in power.

But older people? Newly retiring baby boomers have paid for Medicare throughout their working lives. Government has “guaranteed” them everything they truly need and at a controlled price. Why would anyone want to pay out of pocket for a covered service?

Believe it or not, some do - for timeliness, personalized attention or privacy. Or, increasingly, because doctors just won’t offer care under Medicare conditions. There’s the annual American Medical Association (AMA) campaign to postpone the automatic Clinton-Gingrich sustained-growth-rate (SGR) fee cuts. There’s a scary new cartoon villain: Big Bad SGR Man attacking grandma.

Something, of course, needs to be done because the overloaded Medicare ship is sinking. Wouldn’t it make sense to let willing people off the ship? Why shouldn’t we encourage people to spend their own money on medical care instead of burdening an overstressed system?

The fact is the Centers for Medicare and Medicaid Services (CMS) apparently wants to trap Medicare beneficiaries on the sinking ship. It is acting as though American citizens, once they sign up for Medicare Part B, are not allowed to buy a “covered” service from a physician who does not file a claim for it. The government is having to borrow 40 cents out of every dollar it spends, but it still threatens physicians with a fine of $2,000 for turning down government money - at least if they accept any payment from the patient.

There is a “safe harbor” called “opting out” for physicians, which requires them to forgo Medicare payment for two years except in emergencies and make their patients give up any Medicare reimbursement. Thousands of physicians have done this. It is much less hassle, however, for physicians just to disenroll from the program. Also, this leaves open the possibility that patients could collect at least a portion of the benefits for which they have paid by filing a simple form CMS 1490S.

As far as we can tell, there is no law forbidding Americans from buying care from a non-enrolled physician once they sign up for Part B. (Note that CMS requires a physician to enroll before “opting out.”) This is America, not Canada or North Korea. But CMS is still threatening doctors who accept the patient’s money with a $2,000 fine.

Non-enrolled or disenrolled physicians don’t cost the system anything and can’t defraud it. In fact, CMS keeps making it harder to enroll - to save money and prevent fraud. If some patients file a claim, the amount CMS pays would be no higher than what it would pay to an enrolled physician.

Isn’t it just absurd to threaten physicians for saving the system money while providing service good enough that patients are willing to pay for it? Surely, the reason isn’t to get nonproductive, non-taxpaying benefits recipients out of the way sooner, without the need for controversial death panels.

More likely it is to preserve the power and cash flow to the massive special-interest groups that “manage” and control the Medicare dollar. How much of it is drained into the administration of Medicare’s price controls, based on the AMA’s lucrative current procedural terminology (CPT) coding monopoly and its special committee to calculate how to divvy up the fees?

Big Bad SGR Man is just a boogeyman. The real threat to grandma might be CPT Man, his minions and other middlemen that suck up a big share of the medical dollar. How much? Could it be 40 percent?

If we let some patients pay for medical care the way they pay for groceries, we’ll find out the true free-market price. Apparently, that is a terrifying prospect to somebody. That would explain the threat to use the law enforcement powers of the federal government against Medicare-free doctors.

It’s not to protect Grandma from spending $50 on a doctor visit instead of, say, lottery tickets. Maybe it’s to protect the AMA, which has $50 million to $100 million in annual revenue from its codes at stake. What if the system those codes support is shown to cost doctors and hospitals more than the $200 billion to $300 billion the sustained-growth-rate cuts are supposed to save?

Dr. Jane M. Orient is executive director of the Association of American Physicians and Surgeons.

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