Comb through the fine print of the massive balanced-budget
bill passed last month and you'll find some nasty little
surprises, but perhaps none so egregious as this: a provision
that makes it virtually impossible for seniors to use
their own money to purchase medical care from their doctors.
Incredible, yes, but true. As one of the prices of support
for the balanced budget bill, the Clinton administration
insisted on a provision that effectively bans seniors
from purchasing medical services outside of the Medicare
"framework." How the administration accomplished this
feat is a case study in the way Washington really works.
White House officials knew that a law baring seniors from
spending their own money on health care would be politically
unpopular. So they put the pressure on the doctors instead.
Under the new Medicare rules, any doctor who contracts
privately with even one Medicare- eligible patient for
a single medical service will lose the right to treat
all Medicare patients for two years. The message to seniors
and their doctors is clear: You will play by our rules
or not at all. The Clinton administration wants every
senior to live under the same, restrictive Medicare system.
Every medical decision seniors make must be approved by
the ever-watchful gatekeepers in Washington.
Sen. Jon Kyl, Arizona Republican, says if similar rules
were applied to Social Security, seniors would be effectively
barred from doing business with a stockbroker. They would
have to get their retirement income from the federal government,
and only the federal government. Any "private contracting"
for additional income would subject stockbrokers to penalties
so severe they would decline to do business with seniors.
This new Medicare provision violates a basic, no, the
basic, principle of American life: freedom. But what should
be obvious, that seniors have the right to use their own
money to purchase the medical care they deem necessary,
is not obvious to certain lawmakers. In fact, they find
it downright sinister that seniors and their doctors would
exercise this free choice.
What's more, this provision sets up a two-tiered health
care system in which anyone under age 65 is free to contract
privately for health care while those over 65 run into
costly bureaucratic hurdles. I wonder if anyone has looked
into whether this provision violates federal laws against
age discrimination. If not, they should.
As for doctors, here's my prediction: Fewer and fewer
will take Medicare patients. Medicare payments are already
30 percent lower than what private insurers pay. Now doctors
are told they can't charge a dollar outside the Medicare
system or they'll lose all their Medicare patients for
two years. An increasing number of doctors will decide
treating Medicare patients has become too much of a burden.
But that's what you get when you try to turn health
care for seniors into socialized medicine. Think that
comparison is unfair? It is, to socialized medicine. As
the Wall Street Journal first noted, seniors in Great
Britain, a pioneer of socialized health care, actually
have more freedom to contract privately with their doctors
than American seniors have under this new rule. In fact,
Mr. Kyl says his legislation to repeal this rule will
use the same language that gives British seniors full
freedom to pay for private treatment.
In Canada, by contrast, where private contracts are
illegal, a perverse situation has arisen in which some
seniors travel across the border to the United States
for medical care while less- affluent seniors remain trapped
in an unresponsive government system. This is where America
is heading, some seniors traveling to get the care they
need while the rest make do with substandard care, unless
this provision is repealed.
The good news is that something is being done. Some
members of the House of representatives have already introduced
legislation that would strike this odious Medicare provision.
In plain language, the legislation - called the Medicare
Beneficiary Freedom to Contract At of 1997 - would kill
the requirement that doctors who enter into private contracts
forgo any Medicare reimbursement for two years. For good
measure (not that this should even be necessary) the legislation
would clarify that nothing in Medicare law prevents beneficiaries
from entering into private contracts.
Sure it's self-serving: Members of Congress who went
along with this absurd provision now posing as champions
of seniors' rights by vowing to undo their mistake. But
let's not quibble. What's important is that they restore
to seniors the same medical choices available to every
Sandra Butler is president of the United Seniors Association.
This article appeared in The Washington Times,
October 1, 1997. Copied with permission.