it was being pointed out that they also worked many years and paid taxes that went for others medicare. You are not doing anything they haven’t already done. Also as has been pointed out medicare is everything but a free program. It is not just they have paid in the past, but what they still pay. Anyone who believes this program is free just has not yet experienced it.

I live in an area where virtually all doctors, from adult med to family practice to all the various specialties, belong to one 300-doctor clinic association. They all conduct business according to the same rules. There is no competition as you describe, so in this instance, I don’t see how your plan would work unless patients accepting the burden of traveling to see doctors elsewhere. And if a member of my family is sick, I’m sorry, but I would rather get them local care than take them on a 2-hour drive.

That same clinic has been turning away new Medicaid patients for several years. We do have a small clinic for low income residents, which does get some financial support from the for-profit one, but even after a recent expansion they have given up on keeping waiting lists due to the extreme demand.

Currently the for-proft clinic is lobbying the community for permission to build a large cardiac care center. This would complement their existing cancer center, spine center, sports medicine center, etc.

I agree that citizens need to be more aggressive with the government. However, I also think there are actions that the medical profession can take to cut costs of delivering care. One is to avoid bloated administrations. Our for-profit clinic has a list of vice-presidents, directors, and officers that is staggering. The more management-heavy any business is, the less effectively it operates.

Another is to focus on providing good primary care rather than funnel so much money into the speciality centers.

Obviously these comments are not directed at those of you in private practice, and I wish you the very best of luck.

Here is a solution: Medicare must lift its unreasonable restriction on allowable charges and doctors and other providers should be able to charge as they like and as they need. Medicare should offer the allowable payment and the patient should be responsible for the difference. If I can provide some services at the “allowable” rate but charge more than that rate for other services, then I should be allowed to do so. If I beat out the other providers on price for comparable services and get practice business that way, so much the better. If I don’t and others do, likewise.

I shouldn’t have to enter into onerous contracts with patients when I want to charge more than the Medicare rate. Patients can decide if I am worth the difference. If my costs require I charge more, I should be allowed to do so without suffering penalizing exclusions from participation with Medicare, and my patients should not be cheated out of their benefits by the government for choosing to do professional business with me.

I am sick of this system too. Remember, I also pay taxes. I also expect to have medical benefits in retirement. But I also have to deal with the government in ways you do not, and I think the system as it is cheats me by requiring me to provide money-losing services.

If you have a better idea that has a hope of working, I am all ears.

As for who gets to work changing anything, remember you can vote, because that is how this change is going to have to happen. Don’t whine to me about that, because neither I nor any other doctor nor the medical profession as a whole is going to change things for you.

That’s what the hell we’ve been doing every year when we’re threatened with fee reductions. Even if we drop out of Medicare (I personally plan on going non-par unless there’s a fee increase for 2008), we are limited in what we can collect to 115% of what Medicare allows. Collect anymore and it’s a federal CRIME. As non-par, the check goes to the patient. If we drop out altogether, which we all should (but, hey, docs arent allowed to unionize or strike), we have to sign individual contracts with each patient, and, you, my friend, get no reimbursement back from Medicare. The reason we’re grumpy is that we actually do give a damn about not leaving our seniors in the lurch and without medical care, but the only way this bullshit system will change is if we all do exactly that. We give a damn, but because of that, we soon may be out of business. So, hey, what the hell? At this point, the only way we will change things is to tell Congress to shove Medicare and Medicaid where the sun don’t shine, and JUST SAY NO!!! And, YOU also need to let Congress know, that as a Medicare recipient, you’re pissed as hell.

Do you want us to tip you, over and above what you charge us? you know, give us good service and we slip a 50.00 in your hand on our way out? Maybe if we give your receptionist a 20.00 when we sign in, she will move us ahead so we don’t have to wait 2 hours in your waiting room? People do that often at supper clubs. I won’t tell medicare about it if you don’t. Would that put you in a good mood? it sure seems to make waiters happy. You want to be treated like a waiter? You want me to go to the grocery and buy 100.00 worth of groceries and drop them off on your door step, a couple times a year? fine, give me your address and I will go shop so you can feed your family.

You get angry at us, and honest to God, we don’t know exactly what it is you want. I mean we pay all our co-pays, all our supplemental payments, we go to your office when YOU tell us to, and on the way out, I pay whatever they tell me, or when I get a bill I send you a check. What is your legitimate problem with me? It is because you are stuck with excepting what medicare tells you to accept. You want to charge me more than you have agreed to accept, and now you have some sense of entitlement to believe it is right for you to take that anger out on me. Your pissed at the entire program. Well, so am I.

You hear us say that we are paying out 15K a year in medical expenses, and you only see a small portion of it. I would rather give what I have to pay for medications to you. I would rather give you the 5 K. a year i pay in supplemental premiums, but, this is the way our current medical system is set up. you sir, are a part of this system. It is your profession. Stop whining about it and work to change it.

No one on this thread has made a more disjointed post than you have. And instead of providing a reasoned argument why your case should make more sense than anything else posted, you have resorted to name calling and disparagement. All in all, you haven’t been very convincing.

You seem outraged that you still have to pay medical bills after having paid federal Medicare taxes while you worked, something another poster reminded you does not make you unique, and your Medicare part B premium and supplemental premium. Tell me, how does that make you so aggrieved? Are you angry because your supplemental insurance is expensive? Are you angry because your medicines are expensive? Fine. I could understand why that might be upsetting. But you didn’t say that. Instead you seem outraged to read that doctors aren’t satisfied with what Medicare–not you, mind you–pays them for providing services to beneficiaries like you. Why does that seem unreasonable, if in fact the reimbursement does not adequately cover their costs? It wouldn’t be unreasonable in any other line of services. It wouldn’t be unreasonable to other professional medical providers, like dentists, who don’t by and large have to work under federally-enforced price-fixing. It seems you can’t grasp how a system could leave you with large residual bills and still underpay those who service you. Really, that isn’t all that hard to grasp, when you consider how many people are demanding services, drawing benefits at an age that when Medicare was set up was far closer to the natural average lifespan than it is today.

You haven’t offered much here except calling doctors who post here “nut cases” and other similarly unhelpful statements. The statement by another poster, comparing the high cost of end-of-life care paid for mostly by Medicare to the cost of preventative medicine programs like childhood vaccinations (and obviously not paid from the same budget) was a rhetorical illustration on the present uses of public funds and their relative utility. No one suggested you be dunned to pay for vaccinations, or did you just not get that?

Whether you like it or not, and whether you voluntarily change your expectations or not, the Medicare program in which you now participate will have to change. You may believe that cutting reimbursements is OK, but the harsh reality is that cuts of that kind will ultimately reduce access, and it will likely do so unevenly, affecting those who live where practice business margins are slimmest already. Neither you nor I have to like it, but that is the way it will be. There are alternatives, but those will require a willingness to accept that not everyone can have everything.

I am NOT the above poster, but I have one question: When you go to your doctor for a visit, does it matter, for the purposes of the expenses, costs, and time for THAT visit, how much money you have spent in the past? Once you decide to come in the door, your spending history is irrelevant, just as your spending history for groceries has no impact on the price of broccoli you will pay.

You say you did not make the decisions that led to the insurance plans the doctor will accept, etc., similarly, the doctor was not involved in the financial deicisions you made in the past that make paying for your healthcare difficult today. You could have planned ahead and maybe saved a little more, had a smaller house, etc. I know it sounds crass, but these are the same arguments on this board that non-docs are using against docs who complain about expenses and reimbursement.

So let’s agree that my service today has a value, today. How much I made yesterday, and how much you paid yesterday, are irrelevant. Unless I am you indentured servant, of course.

And by the way, we are NOT the government, and do NOT collect taxes.

You find fault with everyone and everything, no matter what ins. they have, and, no matter how much they pay out in medical expenses.

Do you pay out more than you bring in on medical? So when you hear someone say I pay out more than I make in just one aspect of living, and it is still not enough for you, what is it that you are proposing? Are you thinking that once someone becomes ill they should not receive any medical care at all? If that is the case then we certainly don’t need doctor’s, do we?

You want to talk of entitlements? You take the cake. you may be the most arrogant entitled person I have ever heard talk.

If all you want to do, and deal with, is giving childhood vaccinations, well then why not become a pediatrician and vaccinate away, until your hearts content. And yes, I certainly made sure my own children were vaccinated and paid cash at that time for those vaccinations. How does this have one thing to do with my medical care now? Let parents get their children vaccinated, I hope they do ,but how does this effect me? Are you suggesting that instead of paying my AARP, So that you get paid, and my medicare, and buy my prescriptions, that I should just not get any medical treatment and donate my money to childhood vaccinations?

Your arguments make zero sense and they are all over the place. You give your profession a bad name.

I was not the one who suggested you receive mental health help, but now, I certainly agree with that recommendation. You are sick!

I too see the AARP crowd sucking up resources by the truckload, spending $100,000 of someone else’s money at-a-time for futile care that would otherwise vaccinate thousands of kids, or expand primary care to those without the means or motivation to seek it.

medicaid only compounds the problem – I always cringe when I hear a new patient tell me “I’m fully covered, i have medicare & medicaid” as if they can even fathom how much taxpayers support their medical expenses.