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Returning Medical Freedom to Seniors

By Sandra Butler
October 1, 1997

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 other American

Sandra Butler is president of the United Seniors Association. This article appeared in The Washington Times, October 1, 1997. Copied with permission.