Partisan Attacks on Private Fee-for-Service Plans Debunked.

Editor's note. On page one of the March issue of NRL News, we discussed how NRLC has long recognized that the involuntary denial of lifesaving medical treatment is a form of involuntary euthanasia. Therefore NRLC has opposed government rationing of health care. In 1997 and 2003, NRLC successfully fought to amend Medicare by allowing older people the right to use their own money to obtain unrationed care. Shockingly, under the new leadership of Congress that right is now at risk. Part of that attack is to attempt to demonize private fee-for-service Medicare. But keeping private fee-for-service Medicare is essential if ordinary citizens enrolled in Medicare are to obtain unrationed health insurance.

In a world of managed care and a declining number of providers willing to accept fee-for-service patients under the traditional government Medicare program, private fee-for-service Medicare plans provide a critically important mechanism through which older Americans can voluntarily add their own money to get unrationed health insurance. But if you read a spate of recent press attacks, you'd think these plans were nothing more than diabolical consumer frauds cooked up by profiteering insurance companies.

Many of the accusations are derived from a document issued January 29 by the "Center for Medicare Rights." Shrewdly packaged to sound like a consumer watchdog group, in fact the Center for Medicare Rights has an ideological agenda. Part of that agenda is discrediting private fee-for-service programs by invoking a scare tactic: labeling such initiatives as "privatizing" Medicare. Let's briefly address five misleading or altogether fallacious charges.

1. CHARGE: Private fee-for-service plans (PFFS) are promoted as allowing you to see any doctor, but in fact many doctors refuse to accept them.

RESPONSE: Unless a PFFS plan has a specifically negotiated contract with a particular doctor, the plan must pay doctors at least the same reimbursement as original (government) Medicare. Refusals are not due to a problem with the new PFFS program as such but either because front-office personnel at some doctors' offices are confused about the particulars, or because some physicians consider the rate of reimbursement to be inadequatethe same problem that exists with the original government Medicare program.

PFFS plans have become widespread only in the last year or so, and some doctors' offices may confuse them with other private Medicare plans (the managed care plans that pay lower rates and that have contracts with only some providers). They may not realize that a PFFS plan will pay just as much, or more, as reimbursement under original Medicare.

Beyond educating providers, one solution is for PFFS plans to raise the reimbursement level above that of original Medicare, and adjust premiums accordingly. Original Medicare cannot do this without raising taxes. The answer is certainly not to abolish the PFFS option, which would eliminate older Americans' only alternative to either seeking out a declining number of providers willing to accept patients under the original Medicare program or to accepting managed care.