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November 8, 1993

There Is a Conflict of Interest in Treating Medicare Patients-Reply

Arch Intern Med. 1993;153(21):2506. doi:10.1001/archinte.1993.00410210133018

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Orient is correct in suggesting that any elderly American has the right to refuse Medicare Part B. But very few will have the means to make that option viable. The vast majority of Americans over the age of 65years are retired; they are not covered by an employer's group policy. For these people, individual health insurance policies are rarely accessible and even more rarely affordable. Moreover, the benefits are generally limited to the difference between the amount that Medicare would pay and the maximal allowable fee under the terms of the policy, which is usually but a small fraction of the actual expense. Although her argument is clearly valid, it does not appear to us to address the real needs of the overwhelming majority of elderly Americans.

While Medicare Part B is a voluntary option, enrollment in Part A is automatic for all eligible Americans. Although physicians whose patients reject

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