Academic journal article Policy Review

Please Do No Harm: A Doctor's Battle with Medicare Price Controllers

Academic journal article Policy Review

Please Do No Harm: A Doctor's Battle with Medicare Price Controllers

Article excerpt

I am a physician, an internist in a solo practice, and I am in mourning for the dignity and nobility of the medical profession.

I started in my current practice in Bergen County, New Jersey, 18 years ago when I took over the practice of a retiring physician. I was seven months pregnant with my first child at the time, and I went into labor while making rounds on a Friday night. I was back at work full-time three days later. I returned to work as promptly after the births of my three other children. It was not unusual in the early years of my practice to find me arriving at the emergency room, a baby under each arm, to see a patient.

I consider myself an old-fashioned doctor. I try to get to know my patients, and their families, in an effort to provide quality care to them. Because I have a large practice, and work 12 hours a day, I have been well compensated financially, but I do not charge outrageous fees, nor do I require my patients to come to see me more than is strictly necessary. I make house calls, and my practice includes a number of patients I care for at no charge. Over the years I have become close to my patients, many of whom are senior citizens; I regard a great number of them as my friends.

These close relationships, the opportunities to comfort and heal, and the intellectual challenges of medicine have been gratifying - so much so that despite the great difficulties of raising a young family and having so little time to spend with them, despite the long hours and intense effort my practice demanded, I have felt, until lately, richly rewarded by my work.

Patient Against Doctor Against Government

Most physicians know that this level of devotion to our profession is disappearing in America. Government intervention in medicine has taken away the dignity of the physician and the privacy of the patient-physician relationship, and it threatens the financial viability of private practice. Government price controls have restricted many physicians' freedom to care for government-insured patients adequately, reduced the number of physicians willing to care for these patients, and still has not reduced overall medical costs. Mountains of paperwork and continual wrangling with health-system bureaucrats are distracting physicians from the more important work of treating the sick, while shrinking profit margins and hassles caused by mandatory regulatory compliance are forcing many doctors out of private practice. We are seeing more and more forced rationing of care, especially for senior citizens.

And finally, the government has denied older Americans freedom of choice in health-care purchasing. The Medicare bureaucracy has attempted to prohibit doctors from making private contracts with their Medicare patients, even when no Medicare reimbursement is being sought, effectively turning the large majority of senior citizens in this country into dis-enfranchised, second-class citizens, with little voice in the intimate decisions of their own health care. Together, these federal interventions have degraded the medical profession, pitting patient against doctor against the government.

I decided to act against this degradation, and in 1991, along with five of my patients, I fought one part of the federal health system, Medicare Part B, as administered by the Health Care Financing Administration and the Medicare carriers. Our goal was to regain freedom of choice for those senior citizens who want full access to high-quality health care, as well as privacy and dignity, in their relationship with their physician. Our story is a warning to those who, like the members of Hillary Clinton's task force, believe that the solution to America's health-care problems is government or third-party management.

The Distress of Medicare

My greatest distress as a physician in private practice has come from Medicare, specifically Medicare Part B, and the agencies that administer the Medicare program. …

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