Hands off Medicare

January 22, 1998|By Benjamin L. Cardin

MEDICARE is facing a new attack that threatens to replace the universal health coverage system that now serves America's elderly with a multitiered approach based on ability to pay.

The Medicare Beneficiary Freedom to Contract Act, sponsored by Sen. Jon Kyl, an Arizona Republican, would allow doctors and senior citizens to contract for medical care at rates above those set by Medicare. It would permit doctors to charge senior citizens higher fees than now allowed for services already covered by Medicare.

Bad medicine

In attempting to gain support among senior citizens for this reckless change in Medicare, a number of groups have described this legislation as expanding the choices of care available to the elderly. They have claimed that Medicare's rules prohibit seniors from having the freedom to pay for their own medical treatment.

That's not true. Senior citizens already have the right to pay for non-Medicare-covered expenses such as hearing aids and and routine physical exams.

Under current federal law, physicians who charge senior citizens fees higher than those allowed by Medicare are barred from receiving payments from the government program for two years.

Mr. Kyl would eliminate the two-year Medicare ban against physicians who arrange private contracts with patients.

The two-year limitation is a vital consumer protection because it means that seniors will know when they enter a doctor's office whether that doctor accepts Medicare or requires private payment. It also prevents doctors from charging patients whatever they want based on how much they think a senior can afford to pay.

In 1965, we created Medicare because millions of senior citizens were unable to obtain affordable health care and were forced into poverty as a result of high medical expenses. If Mr. Kyl's bill were passed, we would return to the pre-Medicare days when millions of senior citizens went without medical treatment because they couldn't afford it.

Over the years, we've made improvements to Medicare. For example, in 1989, we enacted ''balance billing'' protections that prevent doctors from charging senior citizens more than 15 percent above Medicare's reimbursement rate. Private contracts would have no such protections against overcharging, leaving seniors vulnerable to massive, unpredictable medical costs.

Many health care professionals oppose Mr. Kyl's bill, including the American College of Physicians, the largest group of primary care doctors in the nation.

Medicare provides seniors with universal coverage while paying doctors reimbursement rates that are sometimes higher than the rates paid by managed care plans. In addition, doctors in Medicare often have more control over medical decisions than do doctors in many of today's health maintenance organizations.

When a doctor contracts with a private health insurance plan to be a provider, he or she signs an agreement to accept that company's reimbursement rates for covered services. No private health insurance plan would permit doctors to privately bill their patients instead of accepting the contracted reimbursement rate.

Just as a private insurance company would not allow its doctors to set their own rates, neither should Medicare.

The writer, a 3rd District Democrat, is a member of the House Ways and Means Committee's health subcommittee.

Pub Date: 1/22/98

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