Cheating Medicare

Hearing my fee, the guest announced that he was on Medicare. I explained that I am not a Medicare doctor, so he would have to pay me up front. Unlike most elderly callers, he preferred another source of care, so I gave directions to a local clinic.

Medicare pays less than the going rate for all medical services. I don’t know any hotel doctor who accepts it. Among the ninety percent of office physicians who bill Medicare, many work hard to tack on extra charges for tests and procedures and length-of-visit to compensate for the low reimbursement. This is cheating, but doctors routinely cheat Medicare. After all, they point out, Medicare cheats them.

Most doctors are conservative, so they blame Medicare’s behavior on government bureaucrats. Being liberal, I blame society. The U.S. is a democracy, and most Americans don’t want to pay enough taxes to finance Medicare adequately. No elected representative, Republican or Democrat, would dream of forcing them.

As a result, a Medicare bureaucrat behaves like any intelligent person required to pay bills without enough money. He quibbles, quarrels, delays, discovers errors in the invoice, makes partial payments and sometimes no payment at all. This infuriates doctors but allows the Medicare budget to last out the year. Paying bills promptly would exhaust the money early, infuriating the bureaucrat’s boss.