One Size Doesn’t Fit All

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When Medicare was enacted 40 years ago, it was intended to ensure vital medical care for those 65 and over. But things aren’t working out precisely as planned. Members of the Boomer Generation, now thinking of retirement, are having difficulty finding doctors to care for them. In many places, medical costs have risen above the limits set by Medicare so that the fees doctors are allowed to charge for treating the elderly are not enough to cover their costs. As a result, some doctors are leaving the field and many others are reluctant or unwilling to accept new Medicare patients. But don’t blame the doctors; blame the program.

Medicare was set up in 1966 to help persons on Social Security pay some of their medical bills. Unsurprisingly, this help came with strings attached – as any entitlement program must. No government agency can give out money indiscriminately. Congress would have been completely irresponsible if it had not imposed rules and regulations to protect taxpayers by keeping costs from mushrooming, and to see that the program was carried out as intended. To protect the elderly from being exploited, and to prevent waste, graft, and corruption, Congress defined the services it would pay for and in many cases placed limits on what doctors and hospitals could charge. At least Congress tried!

The result? Medicare spending has ballooned beyond all expectations. And in spite of attempts to control waste, graft, and corruption, many have succeeded in gaming the system for illicit gains. As a result, taxpayers have suffered. It must be admitted that many elderly have benefited; they have received needed medical care at less than they otherwise would have had to payout of pocket. But those costs are all past, finished, and done for. Some costs are still to be paid in the future. Few- er persons are being attracted to medical careers. Many who envisioned a life of helping others by becoming doctors have become disillusioned, discouraged by the prospect of years of coping with government rules and bureaucratic red tape, and have given up the study of medicine. Moreover, because of Medicare’s restrictions, fewer doctors are choosing geriatrics as their specialty. This is the lesson the Baby Boomers are now learning. And unless things change drastically to lessen the heavy burden of Medicare’s controls and costs and open up medicine to the free market, with its freedom of entry and flexible pricing, Generation Xers will face prospects still more dire.

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