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Fam Pract Manag. 2008;15(3):12

I read “Does Primary Care Need Medicare?” [Opinion, January 2008] by Douglas Iliff, MD, with great interest. Dr. Iliff summarizes one of the many problems we physicians have with third-party payers. We are de facto government employees who operate in an environment of price controls. Medicare sets its level of reimbursement, and all other payers follow its lead. Yet, despite this fact, our overhead expenses are subject to the forces of the free market. How is this a survivable environment for any business?

My private practice quit accepting new Medicare patients a few years ago. I try to limit my Medicare office visits to three per day. The only thing that keeps me contracted with Medicare is my ethical and moral responsibility to our aging population. I am part of the infrastructure of our small medical community, and I am not sure that it will hold if I resign from Medicare completely. This is certainly not what I signed up for more than 20 years ago.

Bravo for Dr. Iliff. As a family physician who had his own practice in Florida – a state with a high percentage of Medicare patients – I can relate to the headaches associated with Medicare. I gave up my practice in Florida and no longer live there.

I concur 100 percent with Dr. Iliff. As a solo physician, I have had similar issues with Medicare. I stopped seeing Medicare patients more than five years ago and have been better off since. The situation will only worsen unless something is done to ease the burden of caring for our aging population.

After reading Dr. Iliff's Opinion piece, it appears that his view and, sadly, that of many physicians, is that the evil federal government is the root of all our problems. Nonsense. The bulk of this country's eye-popping $2 trillion medical bill is paid to private insurance companies who siphon the dollars, then pay – or as often, don't pay – for the care of essentially healthy people. An under-funded Medicare program is left to provide care for the oldest and sickest of our patients. Private insurers don't use the Medicare fee schedule by default; they specifically implement it because it is in their own financial interests. And if insurers can continue skimming while physicians are busy lashing out at Medicare, so much the better.

Heaven knows we shouldn't even consider something like a single-payer or all-payer system that actually pays for health care directly rather than funneling the dollars through an expensive middle man. No, private insurers can relax knowing that physicians will continue to rail against Medicare while company profits soar. In the meantime, they'll be laughing at us – all the way to the bank.


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