REH, first I want to thank you for bringing this issue up again. It deserves to be clearly aired. Some posters have questioned your integrity, requesting/demanding that a copy of the letter be produced. Others have chosen to attack you feeling, apparently, that any questioning of the Medicare system is an attack on Barack Obama and the current healthcare reform legislation.

Neither of these is correct. In support of the information you provided about your cardiologist, I can say from immediate personal experience that The Mayo Clinic no longer accepts Medicare. Medicare covers services provided in the ER and in the Hospital since that is the law. Services provided in the clinic are not. Mayo submits the documentation to Medicare, but requires payment from the patient. Mayo does not bind itself to government approved reimbursement rates. For those of you familiar with Mayo Jacksonville, this means that work performed in the Mayo building will be billed to Medicare while work performed in the Davis building will be billed to the individual. If anyone doubts this, please PM me and I will be happy to provide you with bills I have received of nearly $6,000 for work done in November and December. To date, I have received less than $2,000 in reimbursement from Medicare. This is a squeeze, but I can afford it to receive the best available medical care. Many seniors cannot.

What we are seeing emerge today is a two level delivery system of healthcare similar to that in the UK where the private system (the Harley street physicians) offer significant better and faster care than is available to the general public under the national health plan.

The second issue is whether or not the present proposals for healthcare reform should be considered in an objective look at these issues. My belief is that they should. The present proposals assume a $400-500 billion dollar reduction in Medicare payouts over the next ten years. Savings on this level are not possible without either rationing of services or severe reduction in reimbursement rates. Either would result in an increasing separation of services from those that can afford private coverage and those who cannot.

For those who say reducing fraud and waste can do this; I would refer them to the statement by our Secretary of HHS that there is a potential for a savings of $2.5 billion here but only at a cost of one dollar for every $1.55 saved. This is what, we consider in private industry, a rounding error. Should we go after the money –absolutely, but will it make a difference? NO!

My personal preference is that we start working through this problem with a series of easily done steps. The first of these would be to make existing Civil Service plans available to every company and every person in the United States. This would immediately eliminate the problems of pre-existing conditions, portability, competition and any other issue of ‘evil’ insurance companies profiting on the backs of the people. It also ensures that individuals can purchase plans that they believe are appropriate to them.

I would then propose that we look at tort reform, increasing availability of experimental treatments to those that may be terminally ill w/o fear of finding of fault, overhauling our Medicaid system (don’t get me started on this) and supplemental support for those American citizens who can still not afford adequate health insurance. My first and most basic proposal could pass Congress tomorrow with near universal support from both sides of the aisle. What’s wrong with starting there - a rational, simple step that provides at least half of what we want to accomplish, that can be started in 2010 rather than 2013 and requires very little increase in taxpayer funding? I must be wrong – it cannot be that simple, or can it?