Dear Editor,
I opted out of Medicare three years ago because I could not participate in that pathological system and still practice good psychiatry.

I learned in residency that paying for treatment motivates people to improve. They are more inclined to communicate, cooperate and comply. They make the most of their visits and need fewer of them. They are empowered to make conscious choices about how to allocate their resources.

Dear Editor,

Dear Editor,
...In the early 1990s as mangled care and the government began in earnest to take over medicine, I decided I’d had enough.

Years of government creating crisis after crisis followed by the necessary “fixes” have created a colossal Gordian knot in U.S. medicine. Their solution: repeated government interventions and further collectivism in medicine — never mind that other socialist states have had no greater success in central planning, regulating, mandating, rationing and denying of medical care.

Medicare is going bankrupt. That’s the conclusion of the Medicare Board of Trustees in its most recent actuarial report on the financial status of the Health Insurance Trust Fund (known as Medicare Part A), the fund that pays hospital bills.

Dear Dr. Faria,

I do enjoy and benefit from reading the Medical Sentinel — cover to cover. Congratulations!

And thank you for your efforts to expand the readership of Code Blue. I still believe that it properly and accurately records the historical data showing the gradual permeation of the socializers. Even today,  Ted Kennedy points to recent questionable legislation as a door opening factor toward an ultimately planned for government single payer plan. The battle continues!

In 1863, the federal government passed the False Claims Act in order to combat overcharging practices during the Civil War. The perception was that government suppliers were submitting false claims for reimbursement by the Union, and this Act authorized the government to bring civil actions for refunds and penalties against such suppliers.

We in AAPS are dedicated to the principle that the best medicine is practiced when the patient is in charge, with the physician acting as his ally. And nothing empowers the patient more than being able to direct the money being spent for his own medical care. Patients need to know the cost, but also they should profit, from both a personal and economic standpoint, by being an intelligent consumer.

Any time a third party is interposed between physician and patient, there is loss of privacy and freedom.

John S. Hoff of the American Enterprise Institute attempts to elucidate the reasoning and facts surrounding the bureaucratic prohibition of the right to privately contract between a Medicare-enrolled senior citizen patient and his or her chosen physician in this small booklet. Unfortunately, the book itself unknowingly adds to the wealth of errors which surround this subject.

New Medicare E&M Service Documentation Requirements

Dear Dr. Orient,

I have so many articles piled up on my desk that I want to share with you and other AAPS members, it's becoming more and more difficult to get to them all.

In the event that I end up in jail, however, for participating in the non-violent march to the local IRS office with other members of the Independent Citizens Committee for the Fair Treatment of the Lapp Family, I just had to get this one last piece off. It's a real gem!

They're federal agents...they're coming through the front door of YOUR office to conduct a Medicare investigation...their guns are drawn and they're pointed in YOUR direction. Tiny little beads of sweat start to form on your forehead as you peer down the barrel of the agent's gun, anxiously waiting for what comes next. Make my day? Nope. A riddle: What's vague, undefined and can hurt you...a lot? Answer: "Medical Necessity."(1)

At our national meeting in Raleigh, North Carolina last fall, there were many presentations on the Kassebaum-Kennedy law provisions allowing for the investigation of fraud and abuse in the Medicare system. Physicians, it now seems, potentially face armed invasion of their "private" offices by federal agents who will be enforcing the ever increasing regulations of this misguided program. These new tactics, this escalation in the use of intimidation and terror, will come as no surprise to those who have examined the political and philosophical basis of Medicare.

Dear Patients,
Starting on January 1, 1999, HCFA's new E&M guidelines will be imposed on practicing physicians. The new E&M guidelines request the physicians to practice medicine according to federal, descriptive, required, outlined, specific details. New federal requested guidelines will authorize "armed" auditing agents to enter doctors' offices, unannounced, to inspect and/or audit private patient charts (your chart) without your previous informed consent.

Dear Editors,
Thank you for providing information on how to "opt out" of Medicare. I followed your instructions to the letter and proudly enclose notification by my local carrier that my affidavit meets all the required criteria to privately contract with my Medicare patients without interference by oppressive HCFA bureaucrats.

To celebrate my new independence, I have donated a one-year subscription to the Medical Sentinel to both the local public library and to our local AHEC (Area Health Education Center), neither of whom were aware of its publication.

Dear Editor,

All you skeptical physicians thought the only thing HCFA wants to recoup from you is money. An article in American Medical News tells us that "The E&M flap is the perfect opportunity for HCFA to recoup some of the physician trust it has lost over the years."(1) Of course the same article tells how a Medicare carrier, Connecticut General Life Insurance, demanded close to a million dollars in refunds from doctors in North Carolina because of a mistake made by the Medicare carrier. Sound familiar?(2)

After a long wait, we have finally heard from the U.S. Court of Appeals for the D.C. Circuit in the United Seniors v. Shalala. You can read the full decision at http://www.aapsonline.org. This was to be the suit that helped establish the right of a physician to deal privately with a Medicare patient outside of the Medicare system, or to "privately contract." I must admit, however, that as I read the words in the actual decision, I was filled with disillusionment and dismay.

Inflammatory HCFA Notices

Lois Copeland is a dedicated physician. She is providing courageous leadership to protect the freedom of Medicare patients and their doctors. However, her review (Medical Sentinel, July/August 1999) of Medicare Private Contracting --- Paternalism or Autonomy is ill-conceived. The statements in that review are irrelevant to the substantive issue and factually incorrect.

In normal times, the relationship between patient and physician has been based on an implicit, voluntary understanding or contract. Is it possible that a physician's relationship with a Medicare-eligible patient must now be codified in a legal document meeting narrow specifications defined by the federal government?

Beat your plowshares into swords and your pruning hooks into spears;
let the weak man say, "I am a warrior"
Joel 3:10

Introduction

The revolution in health care financing and its impact on health care services itself has approached a watershed moment. American society has reached a critical position because of a momentous shift in financial control from the user of the medical service (e.g., the patient) to a third party payer (e.g., management company or government) who is the purchaser but not the user of the medial services in question.

In my testimony before the Ohio State Committee of the Legislature on April 12, 2000, as a past president of AAPS, I explained: "to memorialize Congress to repeal existing laws and oppose the adoption of future laws that interfere with the right of Medicare beneficiaries to enter into private, voluntary legal arrangements with their physicians."

Once upon a time...in 1991, Medicare allowed Dr. Freeman A. DoRight to charge $101 for an ultrasound procedure. Shortly thereafter Medicare instituted a scam called RBRVS. Using the RBRVS scam, by January 1, 1999 Medicare lowered the fee that Dr. DoRight could charge to $16.05. Hardly worth the effort for $16.05, but Dr. DoRight continued to provide the service to his patients.

Reasons Against Current Medicare Guidelines

As government attacks against physicians increase in our country, there is faith that ethics will prevail and hope that action will be taken by ethical organizations. We simply cannot afford to sit on the sidelines and watch government abuse our colleagues and demean our profession. We must not only fortify our defenses but we must go on the offense to "win the war."

The U.S. government's Medicare program became effective in 1967. It was supposed to help senior citizens get medical care. Although it now costs ten times more than predicted, many feel that it has helped elderly patients significantly.

But how much harm does it do? Government and academic researchers back away from even asking such a question. Recent events show how Medicare is destroying trust between patients and doctors in the name of cost cutting, fraud prevention, and other tangential issues.

Dear Editor,
We already have national health insurance. It is called Medicare.

In just a few short years, you will reap all the rewards and suffer all the consequences of this system, because you essentially have no other options.

Every year, Medicare costs more and delivers less. Medicare beneficiaries already reap five times more from this system than they pay in. Don't expect Medicare to save you when you reach retirement age.

Freedom will always work better than regulation. Take for instance, the impact of a change in worker safety regulations in New Zealand described by Maurice McTigue, a former New Zealand legislator and official now working at the Mercatus Center of George Mason University (http://www.mercatus.org).