Why I Will Not Take Medicare Money or “How Russ the Plumber got Flushed”

By Jane M. Orient, M.D.,

My reason for not accepting government money is a letter dated Feb 4, 1974, the year I graduated from medical school. My father, who owned a small contracting business, thumb-tacked it over his desk, to remind him not to bid on government jobs.

The letter from Russ Plumbing Company, one of his best subcontractors, reads as follows:

“According to your government, the powers that be have decided that we have exceeded our allowable profits in 1972 at the rate of 1/13th of 1%. Continue reading

Medicare Rationing Begins in January, 2011

An article by AAPS Director Richard Amerling, MD was featured today at Medical Progress today:

House and Senate Democrat leaders, and President Obama, argue that they can “pay for” health insurance “reform” by cutting $500 billion from Medicare spending over the next decade—largely through arbitrary reimbursement cuts,— without reducing the quality of care delivered to beneficiaries.

Yet, in January, 2011, Medicare will implement a new payment system for patients receiving dialysis for end stage kidney disease that will severely ration care to this vulnerable (and largely minority) population based on equally arbitrary payment reductions. These patients will be the unfortunate canary in the Medicare coal mine: “reform” legislation will expose millions of Medicare patients to rationing and reduced quality of care.

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Myth 24. Medicare is the model of efficiency and fairness.

Medicare is immensely popular, has very low administrative costs, is already a working model,… it is said: Why not just have Medicare for all?

At one time, calling Medicare “socialized medicine for the elderly” caused stunned silence in the Congress. Now, if one opposes “socialized medicine,” at least one listener is bound to dare you to say you’re opposed to Medicare. Continue reading

Medicare veto override a triumph for single-payer advocates, Krugman writes

Ostensibly, the vote was against pay cuts for doctors. But it was really about “creeping privatization of Medicare,” writes left-wing columnist Paul Krugman.

Krugman blames Medicare deficits on the Medicare Modernization Act. Not Part D, but Medicare Advantage private fee-for-service plans. He asserts that these rapidly growing plans cost the government 17% more per beneficiary, while threatening to “undermine Medicare’s universality.” Insurance companies “cherry-pick healthier and more affluent older Americans, leaving the sicker and poorer behind”—in the wonderful “traditional” Medicare system that leftists want all Americans to have.

Krugman notes, correctly, that previously payments to doctors were maintained through “bipartisan fudging.” That is, “politicians from both parties got together to waive the rules. In effect, Congress kept Medicare functioning by expanding the federal budget deficit” (NY Times 7/11/08).

President Bush vetoed the bill preventing a 10.6% cut in Medicare fees because it was attached to payment cuts to Medicare Advantage plans. In addition, in his veto message he stated: “[The bill] would imperil the long-term fiscal soundness of Medicare by using short-term budgetary gimmicks that do not solve the problem; the result would be a steep and unrealistic payment cut for physicians—roughly 20% in 2010—likely leading to another expensive temporary fix” (Iglehart JK, N Engl J Med 10.1056/NEJMp0805760).

Krugman is exultant because the Democrats’ ability to stop a filibuster and override a veto make “the odds of achieving universal health care, soon,…look a lot higher than they did just a couple weeks ago.”

The AMA also celebrated, calling the legislation a significant victory. Through paid advertisements, the AMA exerted intense pressure on Republican senators initially opposed to the measure, Iglehart noted. The bill also staves off the scheduled 2009 cut.

“Good job, AMA leadership,” writes Dr. Thomas LaGrelius, president of the Society for Innovative Medical Practice Design (SIMPD). “You made the enemy very happy.”

The bill also killed competitive bidding for new equipment, which reportedly would have saved the program billions of dollars. For example, copayments for an oxygen concentrator for Medicare beneficiaries now total $1,428 over 36 months—more than double the purchase price. Medicare rents it for $198.40/mon, and the copayment is 20%. Medical equipment suppliers lobbied fiercely against this provision (Consumer Power Report #136, 7/18/08, citing Michael Leavitt, “Will Congress Continue a Medicare Scam?” Wall St J 7/9/08). (DME suppliers posted numerous comments in response to this article, regarding the value of the follow-up services they provide, and the Medicare rules and regulations.)

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