New Medicare law sparks political debate

Art Nadler

Friday, Jan. 2, 1998 | 11:17 a.m.

A new law affecting Medicare went into force Jan. 1 that has Democrats fighting for continued governmental control of doctors, and Republicans battling to free up the relationship between doctor and patient.

Since Medicare began, doctors have been told by the federal government what fees must be charged if they decide to care for patients under this program.

Now, under the Balanced Budget Act of 1997, doctors have been given the option to enter into private contracts with seniors for services normally covered by Medicare.

Entering into private contracts will allow seniors to broaden the scope of health care available to them, such as seeing a specialist that might not have otherwise been approved. In the past, they were limtied by what was allowable under cost-conscious Medicare.

The political battle is brewing over a catch in the law, stating that doctors who sign private contracts with seniors are prohibited from participating in the Medicare program for two years.

Republicans want this two-year prohibition revoked because they say it treads on individual freedoms. Democrats say the stricture is necessary to protect the elderly from physicians who may try to take advantage of them.

Also, a conservative group called the United Seniors Association has filed a lawsuit against Health and Human Services Secretary Donna Shalala in U.S. District Court in New York, seeking to block enforcement of the new law.

"You have people in Great Britain and Canada who have the right to do this (enter into contracts), and in America you are telling people they don't have this right," said Rep. John Ensign, R-Nev. "Where does taking away our freedoms stop? Because a few seniors may be duped, you are taking away the rights of others."

Ensign is co-sponsoring legislation called the Medicare Right to Contract Bill, which he said would repeal the new law and its penalty against doctors who enter into private contracts with seniors. He's hopeful Congress will act on it when it reconvenes.

Sen. Richard Bryan, D-Nev., said this new law at least gives doctors an option.

"You don't want to create a situation where the patient is confused," Bryan said. "The patient may have already paid under Medicare and then gets a bill from the physician. How can we make sure that Medicare isn't billed for what a physician has already collected privately?"

Dr. Mitch Keamy, president of the Clark County Medical Society, sees the whole situation as being inconsistent and complicated.

"The government needs to make up its mind if it wants to let the marketplace do this, or get into regulation," Keamy said.

Keamy said the medical society is opposed to anything that would take away a patient's right to choose a physician, or hinder relationships with specific doctors.