Medicare was created by a law in 1965, which states in part that there shall be no “federal interference in the practice of medicine or the manner in which medical services are provided”. In addition, the government is barred from interfering with the operation of any health care facility.
While this was meant to assure seniors that the system that they paid into over their many years of employment would always be there for them, this now translates into creating financial pressure but not taking any responsibility for the results.
When acting as an advocate for patients and confronting health insurance personnel about pre-certification rejection, I have actually been told the following. “We are not telling you how to practice medicine. We do not have the knowledge to do that. You are the one with the expertise. If you feel that something should be done medically for the patient, then you must do it. But while we don’t have the right to tell you how to practice medicine, we do have the right to say that we will not pay for it.”
So, what happens when procedures should be done for those patients who cannot afford them unless the insurance company will pay for it? Well, a certain percentage will forgo having it done and pray for the best.
The malpractice lawyers are waiting in the wings, salivating, rubbing their hands and getting ready for their commercials- “ if you are suffering from xyz disease and haven’t had this procedure, call 1800 Ima-lawyer and we will further punish your physician and sue.”
Is it any wonder that both seniors and the medical community are nervously waiting what the real financial status of Medicare will be?
