Where I Stand: Reader sends up a red flag for seniors on Medicare

Thursday, Nov. 6, 1997 | 10:19 a.m.

SUN READER Horace Therrien received an alarming note from the United Seniors Association berating President Clinton, Speaker Newt Gingrich and Majority Leader Trent Lott for "rationing health care" for anybody over age 64. USA wants petitions sent saying "In America I should have the right to contract with my doctor to receive whatever health care treatment my doctor recommends and I want to pay for."

Oh, by the way, USA also wants a check for $10, $15, $25, $50 or $100 or whatever you can afford.

Looking into the claims by USA I found they are generally accurate interpreting the new health-care restrictions. What started out to protect patients may very well have wound up being overly intrusive and less than protective. Nevada senior citizens probably would have greater impact by writing their senators and representatives personal letters than they would with a contribution to USA.

Congressional Research Service explains the history of this problem as follows:

Private contracting is the term used to describe situations where a physician and a patient agree not to submit a claim for a service that would otherwise be covered and paid for by Medicare. Under private contracting, physicians could bill patients at their discretion without being subject to upper limits specified by Medicare. The Health Care Financing Administration (HCFA, the agency that administers Medicare) had interpreted the law to preclude such private contracts. Some physicians recommended that the law be modified specifically to allow such arrangements.

The Balanced Budget Act of 1997 (BBA97) included language permitting a limited opportunity for private contracting, effective Jan. 1, 1998. However, if and when a physician decides to enter a private contract with a Medicare patient, that physician must agree to forego any reimbursement by Medicare for two years. The patient is not subject to the two-year limit; the patient would continue to be able to see other physicians who were not private contracting physicians and have Medicare pay for the services.

The BBA97 provision has been the subject of considerable controversy. Proponents of private contracting are seeking to expand the provision arguing that any limitations are unwarranted. Opponents of private contracting support the two-year exclusion as a disincentive for physicians to enter into these arrangements. The Medicare Beneficiary Freedom to Contract Act (HR2497; S1194), introduced by Rep. Archer and Sen. Kyl, would remove the two-year exclusion.

An attached information sheet on private contracting in Medicare tells us that those supporting the restrictions on private contracting believe that "without the two-year exclusion there will be increased opportunities for fraud and abuse, and enshrine a two-tiered system in a statute. They also contend it could open the door to undermining consumer protections. The thought of creating a two-tiered system is that as the better physicians and more affluent elderly opt out of Medicare, Medicare will be left as a welfare program for the elderly. Some feel (the) provision is merely the camel's nose under the tent of eventually dismantling Medicare. They also believe private contracting will result in confusion, double billing and outright fraud. And finally, they believe if this legislation (HR2497 and S1194) is enacted that physicians could coerce many patients who cannot afford it to pay out-of-pocket for their care."

Opponents of the private contract restrictions tell us they will "hurt seniors' access to renowned 'superspecialists' as these doctors will treat wealthier patients under a private contract but not be permitted to take a Medicare patient who needs the same procedure. They believe seniors should be able to pay what they want for medical services they desire, free from government intrusion."

So, there you have it! Write or call Reps. John Ensign and Jim Gibbons and Sens. Harry Reid and Richard Bryan and tell them your opinion.

Again, a call or letter to Nevada's delegates in Washington may be more effective than dollars to USA or some other advocacy group.

Next Monday, Nov. 10, from 9 a.m. 'til noon they will have open house for the Women's Health Clinic at Addeliar D. Guy III Ambulatory Care Clinics. A brief ceremony at 9 o'clock will be followed with refreshments at the 1700 Vegas Drive veterans facility. ... My favorite Nevada historian, James Hulse, will be inducted into the Nevada Writers Hall of Fame at the 10th annual Nevada Writers Hall of Fame and Silver Pen Award. Silver State historians don't come any better than this Lincoln County native. Jim has also gained wide recognition for his books that reach into the international arena. ... Have you ever sailed on a WWII LST in a heavy storm? I have, and therefore have great respect for LST sailors. LST Association of Nevada and the Amphibious Forces will form at Sixth Street and Gass Avenue at 9 a.m. Nov. 11 for the big Veterans Day Parade, according to Eugene J. Dreger, their president.