The U.S. government's Medicare program became effective in 1967. It was supposed to help senior citizens get medical care. Although it now costs ten times more than predicted, many feel that it has helped elderly patients significantly.
But how much harm does it do? Government and academic researchers back away from even asking such a question. Recent events show how Medicare is destroying trust between patients and doctors in the name of cost cutting, fraud prevention, and other tangential issues.
Take cost cutting alone. A year ago, Medicare unilaterally determined that two different blood vessel examinations to evaluate risk for stroke would be "bundled" if the examinations were done on the same day. When the two examinations were done on different days, $32.10 would be allowed. But if the two examinations were done on the same day, only $16.05 would be allowed! Go figure. As a result, patients began getting nasty-sounding letters from Medicare telling them that their neurologist doctor, Lawrence Huntoon, M.D., Ph.D., of Jamestown, New York, broke the law by charging more than $0.00 for his work! Only a government bureaucrat could believe that charging zero could be a sound way to run a business or could get away with such a libel. Dr. Huntoon, who happens to be the President of AAPS, fought back, but, nevertheless, felt he was losing the case because of the bureaucratic mudslide engulfing and drowning him in legalistic muck. Each set of bureaucrats in turn disobeyed the Medicare law. Some falsely told him that their decision could not even be appealed. But Dr. Huntoon's struggle fighting back against the bureaucrats finally succeeded. He showed again and again that Medicare officials had been disingenuous or had outright lied to him, and just this summer, these Medicare bureaucrats beat a hasty retreat.(1)
After a year of hearings and appeals, Dr. Huntoon was totally vindicated. The government finally agreed that the doctor's examinations were indeed worth $16.05 rather than $0.00 and that the lower-level bureaucrats were wrong. Dr. Huntoon spent hundreds of hours fighting this battle so that his patients would have the option of having these clinically necessary examinations. If the zero value had stuck, many patients could not be examined.
The bureaucrats backed off only after attorneys threatened legal action and then only when ordered to do so by higher-ups in Medicare. Although it's against the Medicare law for "any federal officer or employee to exercise any supervision or control over the practice of medicine," the bureaucrats have a glossary of weasel-worded excuses to tell patients and doctors what they can and can't do. The way the laws are written, bureaucrats make the final rules. When the government wants to ration medical care, it cuts the resources (both goods and services) going into the medical system. When the government's own policies bankrupt hospitals, insurance companies and doctors, government officials blame others. Dr. Huntoon says that he now spends more than half his time seeking coverage and justice for his Medicare patients. That's a lot of time that he can't spend taking care of patients. Medicare does the most severe damage by destroying patients' trust in their own physician.
While Dr. Huntoon's appeal was winding its tortuous way through the system, Medicare wrote to many of his patients and told them that he was guilty of a crime because he had charged more than $0.00. These false accusations were made even before the doctor had been found guilty! This libel destroyed many patient's trust in their own doctor.
This loss of trust causes many patients to delay treatment while they seek another doctor. As a result, many patients undergo needless suffering. Medicare should stop micro-managing medical care. The right to make medical decisions should be returned to patients and their doctors. Medicare patients should be given the option of choosing which kind of insurance to buy and how much to spend on it. Real Medicare reform shouldn't make patients and doctors subject to the whims of Medicare (government) bureaucrats.
1. Huntoon LR. Abuse, lies, and audio tape. Medical Sentinel 2000;5(4):121.
Dr. Cihak is President-Elect of AAPS. His e-mail is firstname.lastname@example.org. Dr. Glueck has written extensively on medical, mental health, disability, and medical-legal reform issues. His e-mail is email@example.com.
Originally published in the Medical Sentinel 2000:5(5):172, 184. Copyright © 2000 Association of American Physicians and Surgeons (AAPS)