Doctors: The A.M.A. & Medicare

It was an ironic accident of timing. The American Medical Association’s 115th annual convention in Chicago last week wound up just in time for the doctors to go home to deal with the consequences of Medicare, the social security-administered medical insurance that so many of them had fought against so vehemently and so long.

Awareness that Medicare would become official on July 1 made its potential problems Topic A all through the convention. As he took over the office that he will hold for the next twelve months, the new president, Dr. Charles Hudson, a Cleveland internist, counseled moderation. “There are people who think doom is going to fall in on us,” he said. “I think this opinion is not justified. We are not stepping off the brink into a bottomless pit of professional destruction and despair.” He proposed that doctors “make the most of this new program.” If they do, he suggested, they may help “prevent its extension toward a national health service.”

Choice of Bills. Under the new law that makes 19.1 million elderly Americans eligible for partial Government payment of their medical expenses, doctors have been given a choice between two methods of collecting their bills: 1) they can submit an itemized statement directly to the patient, who must pay it before he can enter a claim for Medicare reimbursement, or 2) they can submit their bills to the Medicare-insurance carrier, thereby relieving the patient of the need to pay out any large sums beyond the first $50—which he must pay in any event. Either way, Medicare pays only 80% of that part of any bill that the insurance company considers reasonable (the patient is responsible for the other 20% of the “reasonable charge”). If a doctor bills the patient, however much he charges, Medicare will reimburse the patient for only 80% of the reasonable amount. The patient, not the doctor, will be minus the “unreasonable” difference.

The choice of billing procedures was extended to doctors in order to permit them to continue the common practice of charging wealthier patients more than others, to help offset the costs of charity work. What the Federal Government hoped was that doctors would bill directly only those patients they expected to pay higher-than-average fees, thus eliminating the possibility that an “unreasonable” excess might be tacked onto the bill of a patient who could not afford it. But when the question came to a vote in the house of delegates, the moderates were overridden and all A.M.A. doctors were urged—though not required—to bill every patient directly. The way some delegates saw it, the Government-preferred billing method somehow inserts Medicare into “the sacred doctor-patient relationship.”

Headaches of Work. Others saw far more potential trouble in the new act—the possibility that it would strain the nation’s short supply of doctors, nurses and hospital beds. On the other hand, Dr. Edwin Crosby, director of the American Hospital Association, saw U.S. hospitals as easily able to absorb the influx of Medicare patients. And most Government authorities agreed. But they also worried lest the A.M.A.’s stand add unnecessarily to the headaches of making Medicare work.

The delegates’ stance on billing was strong evidence that the majority of A.M.A. policymakers are not yet ready to adjust to the new program. The delegates obviously thought that the fight should and will go on. and to prepare for the future they elected Dr. Milford Rouse by acclamation as the next A.M.A. president. Rouse, who will take office in June 1967, is a Dallas gastroenterologist and a former director of H. L. Hunt’s ultra-right Life Line Foundation. As speaker of the house of delegates, he has already made it clear that he will take a far harder line on Medicare than moderate Dr. Hudson.