Medicare: all or nothing. (Editorial).

There is no question that Medicare was initially a success when it was introduced in 1964. Before Medicare, patients who were unable, or unwilling, to pay for medical care simply did without it. At Medicare's inception, a large backlog of patients with chronic, often lifelong, conditions such as otosclerosis, chronic ear infection, nasal obstruction, and hoarseness obtained treatment. Paperwork was minimal, and Medicare paid fees in full. The system worked because medical care was private and efficient. At that time, my annual medical malpractice insurance permium was $250; one day of hospitalization cost $100; and Triaminic with 50 mg phenylpropanolamine cost 10 cents a tablet.

The system has evolved to the point of extreme inefficiency. Well-meaning but misdirected regulators, Congress, bureaucrats, FDA, CMS, OSHA, insurers and, yes, JCAHO and our own medical societies, have created so many rules, guidelines, and restrictions that the efficient practice of medicine in the U.S.A. has become increasingly difficult.

More and more physicians are considering opting out of Medicare, as well as many other payment plans. The December 9, 2002, American Medical News featured the first of two articles by Chicago attorney Steven M. Harris, with an overview of requirements imposed on doctors who elect to opt out of Medicare. (1) He points out that "opting out of Medicare is an all-or-nothing deal. You're in or you're out." Colleagues who have done this say they provide, as a service to the patient, a single bill on a HCFA 1500 form that the patient can submit to Medicare. Medicare pays what it will to the patient directly. The patient pays the doctor the fair and agreed-upon fee.

In our ever-changing world, to opt out of Medicare may be worth consideration.

JACK L. PULEC, MD

Editor-in-Chief

EAR, NOSE & THROAT JOURNAL

Reference

(1.) Harris SM. Contracts required for Medicare opt-out. American Medical News; December 9, 2002: 26-7.

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