In general, when a long-standing relationship is terminated, it is expected that an explanation of the factors which led up to the termination be provided. I, John A. Bennett, D.O., have agreed to associate with the Medicare Program of the United States Government for the mutual benefit of my patients, my practice and the Medicare Program since 1980. I can no longer, in good faith, continue a relationship with the Medicare Program and want to declare to my patients, my colleagues, my community and to my government the causes which have forced me to opt out of the Medicare Program.

The Patient-Physician Relationship is the foundation of the practice of medicine. This relationship is a two-way street. To simplify, the patient receives emotional and medical support from the physician, while the physician receives emotional and financial support from the patient. The emotional interaction is complex and individually variable, but an important interpersonal bond develops between patient and physician. Without this bond, good medicine cannot occur. While it is natural for the patient to seek out a satisfactory relationship, it is the duty of the physician to influence society to establish an environment in which the Patient-Physician Relationship can exist or even thrive.

When the Medicare Program was established by the Federal Government over thirty years ago, it was committed to not interfering with the Patient-Physician Relationship or with medical decision making. Over the last fifteen years however, Medicare regulations have become increasingly onerous. I find now that I must choose between the practice of Medicine and the practice of Medicare; I choose the practice of Medicine. Some examples of the offenses of the Medicare Program against the Patient-Physician Relationship will illustrate the magnitude of the problem.

Medicare has not respected the Principles of Confidentiality. Copies of patient�s records are routinely requested by Medicare administrators.

Medicare has interfered with the medical marketplace to the extent that a marketplace is barely recognizable. Price controls have been in place since 1985.

Medicare has interfered with charitable medical care by threatening prosection of physicians who do not bill their patients for expenses not paid by Medicare.

Medicare has interfered with medical decision making. Clerks and administrators are empowered to rule visits, tests and procedures as "medically unnecessary."

Medicare has criminalized the practice of medicine, setting huge fines for minor variations from arbitrary guidelines; even going so far as to offer large bounties to patients who will suggest that their physician might be a worthy target of investigation.

Medicare has (in essence) enslaved physicians, requiring the completion of bureaucratic paperwork without just compensation, while placing the physician in legal jeopardy if the papers are not properly completed.

Medicare has attempted to divide the medical community, first giving preference to surgeons and other hospital-based physicians over primary care physicians, then giving harsher treatment to the hospital-based physicians while reducing the pressure on office based physicians. Medicare was at all times ready to use the power of anti-trust laws if there was any sense of physician organization.

Medicare has attempted to set patient against physician by using inflammatory language on the "Statement of Benefits" letter to patients regarding payments made by Medicare to the physician.

Medicare makes the allegation of the "crime" of Fraud and Abuse against physicians in civil court; the physician is assumed guilty until proven innocent, in direct conflict with the traditional American ideal of Justice.

Medicare rules and regulations are so numerous and complex, and they change so frequently, that it is not possible for a reasonably informed physician to know and understand all the rules that must be followed. These complex rules are enforced arbitrarily, as even the enforcers cannot understand them fully.

Medicare rules require that the patient-physician encounter (which is largely a subjective experience) be documented in an objective manner. The time required to document complicated cases is not considered in the formulas and patient confidentiality is not considered. These rules are enforced in an arbitrary manner.

Medicare has held physicians accountable to rules which are unknown to the physician. These secret rules are part of the "Black Box Audits" recently being held.

Medicare has determined that I have provided services to my Medicare patients that were "not medically necessary." When these determinations are appealed, they are often reversed, yet Medicare continues to accuse me of providing services that are "not medically necessary." I find these accusations to be an intolerable professional insult, a statement of "no confidence" and a direct threat.

Being thus required to choose between the Practice of Medicine and the practice of Medicare, I choose to continue to practice Medicine according to my professional training, my professional judgement and the guidance of my God. Despite the certain hardship that my decision places upon my long-established relationships with some of my most close and loyal patients; despite the certain hardship that my decision places upon my practice and my ability to earn a living as a physician in a retirement community; despite the probability that my motives will be misunderstood in the community, I must uphold the Duty that I have to the Patient-Physician Relationship and to the ideals of individual sovereignty that are inherent in that relationship.