A Guide for Patients
WHAT YOU NEED TO KNOW
ABOUT TITLE 18
Freedom of choice
How Medicare affects the doctor-patient relationship
This brochure explains why I have chosen to practice only private medicine.
According to the Principles of Medical Ethics of the Association of American Physicians and Surgeons: "The physician should not dispose of his services under terms or conditions that tend to interfere with or impair the free and complete exercise of his medical judgment and skill or tend to cause a deterioration in the quality of medical care."
Freedom of Choice
When Congress passed Title 18, the amendment to the Social Security Act that created Medicare, it promised not to interfere in the practice of medicine.
This promise has been amended out of existence. If any part of the patient's bill is paid by the government, the patient now has the "right" to receive whatever the government sees fit to provide.
Motion to Affirm Judgment of District Court
AAPS v. Weinberger, 1975
Unlike the "right to die" or the "right" to have an abortion, the right to choose one's medical treatment may not be constitutionally protected. A US Circuit Court has ruled that a Medicare beneficiary may not even spend his own money to buy a service that Medicare regulations say is "unnecessary" (New York State Ophthalmological Society v. Bowen).
When patients file a Medicare claim, they must sign the following statement:
This gives any "authorized" person (authorized by the government, not necessarily by the patient) the right to examine the patient's medical records.
The records of all hospitalized patients are reviewed to be certain that the admission meets government standards for "necessity." If it does not, the hospital will pressure the doctor to send the patient home because payment will be denied. (If the doctor is not "cooperative," the hospital can revoke his admitting privileges.)
Recently, the Peer Review Organization (PRO) has been instructed to start reviewing patients' records in doctors' offices as well.
Effect on the Doctor-Patient Relationship
Medicare patients generally consider themselves to be private patients. Doctors have tried to treat them as such. However, recent Medicare regulations make it clear that Medicare patients are government patients.
When the government pays any part of the bill, the government controls the practice of medicine. Increasingly, medical decisions are being made by clerks employed by insurance carriers or by anonymous government bureaucrats.
Many patients think that their supplemental insurance covers things that Medicare doesn't pay for. But in fact, most supplemental policies cover only 20% of the Medicare-approved charge. If Medicare declares a service to be "worth" $20, Medicare pays $16, and the supplemental policy pays $4. It might have cost the doctor $100 to provide that service, and Medicare might allow a "nonparticipating" doctor to charge $50. The patient in that case would be responsible for $30.
Freedom Is Available
I have chosen not to be a part of the government medical system. My services are available to private patients, regardless of age. We can make accommodations for those who cannot afford to pay. However, the government has decided that patients may not use their Medicare benefits to pay any part of the bill for truly private medical care. It is also possible that the government may determine that patients over the age of 65 shall not be allowed to purchase private medical care, even with their own money. This issue has not yet been clearly tested in court.
We cannot provide you with any paperwork that could be submitted to Medicare (either directly or through another insurance company).
All our private medical records will be stamped with the notice "Confidential service, not covered under Title 18 (Medicare)."
If you should choose to see another doctor, who does accept government regulation and payment, we will be happy to help you by transferring your records.
It is possible for patients to "opt out" of Medicare Part B, and thus avoid paying premiums that are not applicable to private medical care.