I am the Executive Director of the Association of American Physicians and Surgeons, founded in 1943 to preserve the practice of private medicine. I am an internist practicing in Tucson, Arizona. Today, however, I would like to speak as a prospective Medicare beneficiary. I am on the leading edge of the Baby Boomers. Call us PAC-man, with respect to the entire Federal Treasury and not just the Medicare trust funds.

Had I been playing the part of Joey in the entertaining skit that we witnessed yesterday, I would have told the lady with the clipboard: "I am a grownup, not a kindergartner. I do not need a recreational counselor to tell me how to amuse myself." I would not be willing to pay a dime for the services of such a person, nor for the multidisciplinary team, nor for an interdisciplinary team, nor for anyone to spend the time required to fill in 500 items, or 200 items, on the minimum data set (MDS). I do not need extensive data chronicling the progress of my decline into decrepitude at three-month intervals. Such data are of no use to me in selecting a residential facility: I plan to use my eyes, ears, and nose for that purpose. Since I personally would not be willing to pay anything for these items, I believe it is outrageous to impose the cost on my sister's grandchildren.

What I would like to have in my old age is a catastrophic insurance plan, as opposed to the Medicare benefit system, which is an upside-down and backwards system of payment for mandated benefits that I do not desire, and for small and predictable expenses, with guaranteed rationing for the care of expensive illnesses. If I have to be hospitalized, I want to be treated like a paying customer, not like a loser with an unfavorable DRG.

I will trade any number of recreational counselors or other multidisciplinary team members for a policy that does not give hospitals the incentive to kick patients out before they are able to walk.

The Committee informed us yesterday that you do not have the power to effect any major changes. If you tried to do so, you would collide head-on with the type of vested special interests that testified on the panel yesterday.

The fact is that the Medicare system has the equivalent of advanced three-vessel coronary disease, with a clogged left main coronary. It needs a bypass. The purpose of the Medicare Plus Choice program was to provide alternatives. Unfortunately, with few exceptions, all of the Medicare Plus Choice products appear to be managed-care plans, and all are afflicted with the same type of inverted incentives. The greatest disappointment of the Medicare Plus Choice program is that the initial promise of medical savings accounts did not materialize in any actual products. This may be because of regulatory requirements that destroy the advantages of such plans.

The type of plan that I would like would have a very high deductible to be covered by premium savings placed in the medical savings account, supplemented with other savings if necessary, combined with an insurance plan that offered truly catastrophic coverage. Americans should be allowed to purchase such plans when they are in their 20s and carryover the savings into retirement. Had I done so, all of the testimony here today would have been irrelevant to me as an individual because I would have a very well-funded medical savings account plan. However, we have to start sometime and it is better to give Medicare beneficiaries some medical savings account plans now, while the next generation is empowered to fund its own retirement medical care.

No intelligent person would choose the current Medicare benefits structure as an insurance plan. At the present time there is no escape, however, as one cannot relinquish Part A benefits without forgoing all Social Security benefits, and the private insurance marketplace was destroyed by Lyndon Johnson at the time that Medicare was enacted.

To expand on the remarks of Dr. Len Kirschner, it is not just Medicare Plus Choice that is a "screaming, flaming disaster," but Medicare itself-my generation will prove that. It is vitally important to provide those trapped in the program now with some sort of bypass opportunities. All regulations that are hindering the development of medical savings accounts need to be rescinded. Major changes are needed now; it is not a moment too soon.