Plan to let doctors charge more to Medicare users is under fire Democratic leaders say elderly patients would be gouged for care

WASHINGTON — WASHINGTON -- A group of Democratic lawmakers, including Rep. Benjamin L. Cardin of Baltimore, denounced yesterday a Republican plan to allow doctors and senior citizens to contract for medical care at rates above those set by Medicare.

Saying that doctors are paid too little under the government-run insurance program, Sen. Jon Kyl, an Arizona Republican, and Rep. Bill Archer, a Texas Republican who heads the House Ways and Means Committee, would allow any doctor to negotiate a fee for medical care given to anyone enrolled in Medicare.


But Democratic legislators charged yesterday that the Republicans had created a plan that would allow doctors to coerce higher payments from elderly patients.

"It's outrageous, the way this has been framed by Kyl," Cardin said in an interview before a news conference on Capitol Hill.


The "hidden agenda is to dismantle the Medicare system," said Rep. Pete Stark, a California Democrat.

"What we're really messing with here is a stealth amendment that would destroy the Medicare system."

Vincent Sollitto, a spokesman for Kyl, rejected that notion and said that current regulations unreasonably prevented patients from determining whether to pay additionally for the level of treatment they desire.

"The senator has said that he does not see how allowing patients to choose their own doctor should hurt Medicare," Sollitto said.

"Why do we have to deny American senior citizens the right to choose any doctor they want, just because Medicare wants them to jump through hoops?"

Kyl wrote a similar proposal last summer as an amendment to the balanced budget plan.

Congress approved that proposal by a wide margin after scant debate.

When President Clinton threatened a veto, congressional leaders agreed to temper it with the requirement that physicians who charge senior citizens fees higher than those allowed by Medicare be barred from receiving payments from the government program for two years.


The new Kyl-Archer amendment would drop the two-year Medicare ban against physicians who seal private contracts with patients.

"Clearly, doctors are feeling the pinch as other payers, notably the commercial payers, have gotten more aggressive," said Jonathan Weiner, a professor of health policy and management at the Johns Hopkins School of Public Health.

Although it escaped much media coverage until recently, the new measure has generated sharply different visions for the future of the Medicare system, which was set up in 1965 to provide health care insurance for senior citizens as a cornerstone of President Lyndon B. Johnson's Great Society.

More than 35 million Americans over age 65 now receive health care that is paid for mostly by Medicare.

More than 90 percent of physicians accept patients on Medicare.

Cardin asserted that no private insurer would allow its doctors to tell patients that they could receive better care, more promptly, if they paid a higher rate.


"Seniors are very vulnerable -- they're very concerned about their health care needs," said Cardin, one of the Democrats' specialists on health care policy.

"If that doctor tells you that in order to receive your health care, you're going to need to pay what that doctor thinks you should pay, regardless of what Medicare pays, that senior is going to be put in a very difficult position."

A two-tiered system would result, the Democrats contended, with doctors devoting far more attention to their patients who pay for their own care.

Pub Date: 10/09/97