1601 N. Tucson Blvd. Suite 9
Tucson, AZ 85716-3450
Phone: (800) 635-1196
Hotline: (800) 419-4777
Association of American Physicians and Surgeons, Inc.
A Voice for Private Physicians Since 1943
Omnia pro aegroto

A Guide for Patients




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."

Doctor's Name


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.

Nothing in this title shall be construed to authorize any federal officer or employee to exercise any supervision or control over the practice of medicine, or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer, or employee, or any institution, agency or person providing health care services....
Section 1801, Medicare Act, 1965

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.

Patients whose medical care is provided by public funds have no constitutional right to whatever care [their physicians] using "the highest standards of medical practice"...may "judge necessary"... or to obtain that care "from a physician ... of their choice."
Robert H. Bork, Solicitor General
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:

I authorize the release of any medical information necessary to process this claim.

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.

  • The government is setting up "practice guidelines." These will dictate what doctors are allowed to do for patients. Their main purpose is to ration care.

  • The government has the right to demand the patient's records.

  • Government-paid "peer reviewers" are placing black marks ("quality of care points") on doctors' records for "deviations" from "standards of care." These so-called standards are made up by the reviewers. They have never been scientifically proved, and not all doctors agree with them.

  • The government, as of September, 1990, will deny patients the right to submit a claim for their own benefits and will require the doctor to submit the paperwork, under threats such as fines.

  • The government dictates the fee, often based on charges from the 1970s that may not even cover today's office overhead.

  • The government can fine physicians $2,000 or more per "violation" of a Medicare regulation (e.g. for writing the "wrong" code on a claims form, even if this was a secretarial error).

  • The government can deny payment, or demand a refund, for services it considers to be unnecessaryÄeven if the patient requested them. (An example of a service the government found "unnecessary" was the resuscitation of a patient who had a cardiac arrest.) The government has even demanded huge sums as refunds for a long list of services performed years before. Doctors are generally not even allowed to challenge such demands in an impartial court of law.

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.

Supplemental Insurance

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.