Balance-billing will solve problem of physicians dropping out of Medicare

Regarding "AMA to write balance-billing legislation" (Article, July 11):

I urge the AMA to push hard to legalize balance-billing in Medicare, for the following reasons:

Balance-billing is the only feasible solution to the growing problem of access to primary care services facing those covered by Medicare. Right now in Oregon, there are very few primary care doctors accepting new Medicare patients, and those who are, usually are employed by hospitals.

More primary care doctors are opting out of Medicare every year. The ability to balance-bill would solve the problem very nicely.

Right now, there are only two options for primary care doctors: Accept enough money under Medicare allowables to pay no more than overhead costs and take nothing home for your family, or drop Medicare entirely. This is untenable. Lobbying for increased reimbursement has so far been futile and every year it looks more hopeless.

Those patients under Medicare who can afford to pay the doctor for more services are prevented from doing so by a system that seems foreign to them. Patients are alarmed, as well they should be, that they are not permitted to buy what they can afford, even though the seller is willing. What could be more un-American?

Balance-billing is budget-neutral for Medicare. Therefore it is very low risk for politicians. While some would decry a risk for loss of access, I am certain that legalizing balance-billing would increase access.

If doctors can afford to see some patients for less money, they nearly always do so willingly. It is when doctors are strapped for money that they turn nonpaying patients away. For primary care, Medicare is nonpaying, and being turned away by more and more primary care doctors. Balance- billing would solve this problem.

Daniel J. Urbach, MD, Portland, Ore.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2005/08/08/edlt0808.htm.