After reading the Washington Post article that looks back on the start up of Medicare in 1966, I googled “Udall and Medicare” to find documents I had come across a few years ago.  The material from Tucson Congressman Morris Udall provides a view of the debate over Medicare in the 1960s.

In a 1962 newsletter, Congressman Udall shared comments he had received from Arizonans who were for and against Medicare:

Tucson doctor: "I have never had it brought to my attention that anyone suffered from lack of medical care because they were unable to pay for it."

Doctor's wife, Tucson: "I believe it would encourage the placing of our older citizens in institutions instead of encouraging them to remain active members of their community."

Doctor's wife, Tucson: "...will inevitably result in the overcrowding and overutilization of hospitals and nursing homes..."

Prescott housewife: "The aged people do not need this system of help, and it is just another way to take the individual's dignity away from him and make weaker people become captives to a dole system."

Tucson retiree: "The average retired middle-class person, who is the real backbone of the American way of life, cannot stand a major sickness without becoming a pauper. He deserves a greater freedom from fear in his later years."

Tempe man: "At 75 years of age my medical and hospital needs cannot be met out of meager savings and income. Insurance policies cancelled when I needed them most."

The 1962 document with more comments from Arizonans can be found here:  http://www.library.arizona.edu/exhibits/udall/congrept/87th/620601.html

Congressman Udall’s 1965 report on Medicare is also an interesting read:  http://www.library.arizona.edu/exhibits/udall/congrept/89th/650331.htm

Legislation creating Medicare was passed in 1965 and enrollment began one year later, in 1966.  Nobody knew if Medicare would be a success or failure. Would seniors enroll in the program? Would doctors and hospitals participate? Would the country be destroyed by this socialist program?

Five thousand people were hired by the government to go door-to-door to enroll people, 65 and older, into the Medicare health insurance program. The Part B premium was $3 per month, and many seniors said they could not afford to pay that much. (The monthly premium is $104.90 today.)

The American Medical Association (AMA) ran ads condemning Medicare, saying it would lead to socialized medicine. Ronald Regan was hired by the AMA to speak out against the legislation, and he predicted “a thousand years of darkness” if Medicare was implemented.  Here is more of what Ronald Reagan had to say about Medicare:

One of the traditional methods of imposing statism or socialism on a people has been by way of medicine. It’s very easy to disguise a medical program as a humanitarian project. . . . We are against forcing all citizens, regardless of need, into a compulsory government program….the consequences for “our children” would be dire: “we will sentence them to take the last step into a thousand years of darkness.”

The Washington Post has an interesting article that looks back on the startup of Medicare in 1966, titled, “When Medicare launched, nobody had any clue whether it would work”.

The doom and gloom predictions over Medicare in 1966 seem very similar to the anti-Obamacare talk today.  As it turned out, older Americans appreciate Medicare and know how important it is to their health – and to their financial well-being.

Only time will tell if the more than 30 million Americans without health insurance will sign up for coverage in 2014.

Will there be too many patients for the the number of doctors?  In 1966, anti-Medicare voices said hospitals would be overwhelmed with old people wanting care. That didn’t happen.  Ronald Reagan said we would be plunged into a thousand years of darkeness. That didn’t happen either.

“My friend told me lots of doctors are no longer taking Medicare patients”.

This is a statement I have heard from quite a few people who are turning 65 and signing up for Medicare.  The truth is that over 90% of doctors accept Medicare, and probably 99.9% of hospitals accept Medicare patients.  A while ago I wrote about a study that was done on this subject back in 2011.

In Tucson, and in many cities, some doctors are moving to “concierge medicine” where they don’t take any insurance plans and patients must pay a yearly fee to see the doctor. I don’t get this concierge concept since primary care doctors don’t do much for their patients when they have serious health problems – they refer them to a specialist. And how many times per year does a person see her primary care doctor?

There may be some doctors who are not taking any new Medicare patients because they have too many patients. Or, they want a certain percentage of their patients to be paid through Medicare while the rest would be paid through employer health insurance or other private insurance. That is a business decision.

Here is an article provided by the Regional Director for Medicare, David Sayen. He explains what the ramifications are if a person’s doctor decides to opt out of Medicare.

What does it mean when a doctor tells you he or she has “opted out” of Medicare?

An opt-out doctor is one who doesn’t accept Medicare. Doctors who have opted out of Medicare can charge their Medicare patients whatever fees the physicians choose. These doctors don’t submit any health care claims to Medicare. In addition, opt-out doctors aren’t subject to Medicare laws that limit the amount they can charge their patients.

More than 1 million health care providers throughout the United States – the vast majority of them doctors – accept Medicare as payment.

But when you visit a doctor who has opted out of Medicare, you pay the entire cost of your care, unless it’s an emergency or you need urgent care. Generally, Medicare doesn’t pay for health care services you receive from an opt-out doctor.

If your doctor has formally opted out of Medicare, he or she must have you sign a private contract stating that you agree to receive care from a doctor who doesn’t accept Medicare. This private contract only applies to services provided by the doctor or other provider who asked you to sign it.

You don’t have to sign a private contract. You can always go to another provider who does take Medicare. If you do sign a private contract with your doctor or other provider:

·       Medicare won’t pay any amount for the services you get from this doctor or provider, even if it’s a Medicare-covered service.

·       You’ll have to pay the full amount of whatever this provider charges you for the services you get.

·       If you have a Medicare Supplement Insurance (Medigap) policy, it won’t pay anything for the services you get. Call your insurance company before you get the service if you have questions.

A physician or other provider must tell you if Medicare would pay for the service if you get it from another provider who accepts Medicare. Your provider also must tell you if he or she has been excluded from Medicare.

And keep in mind that you can’t be asked to sign a private contract for emergency or urgent care.

You may want to contact your State Health Insurance Assistance Program (SHIP) to get help before signing a private contract with any doctor or other health care provider. Your local SHIP number is available by calling 1-800-MEDICARE (1-800-633-4227).

Most doctors, providers, and suppliers accept Medicare, but you should always check to make sure. (You can always get services not covered by Medicare if you choose to pay for them yourself.)

Providers who participate in Medicare have signed an agreement to accept the Medicare-approved payment for all Medicare-covered services. In other words, they “accept assignment.”

Providers who participate in Medicare have signed an agreement to accept the Medicare-approved payment for all Medicare-covered services. In other words, they “accept assignment.”

Here’s what it means when your doctor, provider, or supplier accepts assignment:

·       Your out-of-pocket costs may be less.

·       Your provider agrees to charge you only the Medicare deductible and coinsurance amount and usually wait for Medicare to pay its share before asking you to pay your share.

·       Your provider has to submit your claim directly to Medicare and can’t charge you for submitting the claim.

David Sayen is Medicare’s regional administrator for Arizona, California, Hawaii, Nevada, and the Pacific Territories. You can always get answers to your Medicare questions by calling 1-800-MEDICARE (1-800-633-4227).