Latest posts by Jane M. Orient, M.D. (see all)
- SOTU 2019 and American Medicine - February 12, 2019
- So What If ACA Is Unconstitutional? - January 8, 2019
- Epidemics, Fear and Denial: How Every American Is Threatened - December 11, 2018
And they don’t address the question of what happens if you don’t like your Medicare.
You can drop Medicare Part B, though there is a penalty for getting back in. But to drop Medicare Part A, you have to give back all the Social Security payments you ever received, as well as forgoing future payments. This was litigated in the case of Hall v. Sebelius, and was revisited in the challenge to ObamaCare brought by the Association of American Physicians and Surgeons (AAPS), AAPS v. Burwell, which the U.S. Supreme Court recently declined to hear.
Why would anybody want to turn down free insurance, you may well wonder—especially when there is no private substitute for it. (President Johnson saw to that, to be sure that “his” program was successful.)
That has to do with your Medicare doctor, and your actual care. Medicare rules are forcing many independent physicians to give up their practice, and either retire early or become employees. Physicians who do remain in practice may not accept Medicare patients, or limit the number they see. If you are a Medicare patient, the entire Medicare regime is in the examining room or hospital room with you, like it or not. You are not allowed to be free for a day. Neither is the doctor. There is a way out (opting out or disenrolling), but that’s an all-or-nothing choice for the doctor.
A Medicare beneficiary can see a non-Medicare doctor as a private patient, but is very unlikely to be able to collect any Medicare reimbursement. A Medicare doctor cannot see Medicare-eligible patients as private patients.
Medicare is also making it increasingly difficult for Medicare patients to get tests, consultations, oxygen or other home-health items, or medications prescribed by a non-Medicare doctor, sometimes even if the patient is willing to pay privately.
Why should this be?
Keep in mind that Medicare is not yours. The money you paid in all your working life is long gone. Your benefits are coming out of the wages of people like Larry, John, and Jesus, who toil at Arnold’s gas station, and all of them are having a hard time these days. Now that payroll tax receipts are less than payouts, benefits are coming out of general tax revenues, which redeem the IOUs in the “Trust Fund.” And the ever-increasing Part B premiums pay only 25 percent of benefits. If you are on Medicare, you are a liability—to your doctor and to society.
Medicare does offer some fine new “benefits”—such as paying for “end-of-life” counseling. And why do you need that?
Death is something that could happen to anyone at any moment. If you have obligations or assets, you need to provide for your survivors. Medicare counseling, however, is not about life insurance, wills, or funeral arrangements—or about making peace with your family or God. It’s about reducing the cost of your care. The most expedient way to do that is to use “end” as a verb.
These days you can no longer assume that a hospital will seek to prolong your life and restore you to the health you enjoyed before you fell ill. It is much easier for the hospital if you give them permission ahead of time not to try. The purpose of the “advance directive” is to decline “life-sustaining treatments”—such as food and water.
Do not assume that doctors and hospitals have to “do everything” just because you said you wanted them to. Increasingly, hospitals demand the legal right to refuse care that is “futile”—by their definition. Medicare’s refusal to pay is a strong motive. Your consent provides immunity. Sedatives, to keep you quiet and peaceful, are cheap.
MIT economist Jonathan Gruber has told us how much the government cares.