But what kind of internal medical practice does not see any patients over 64 years of age?

You are legally bound to see Medicare patients? If you a private physician and don’t work in a group or hospital I don’t think that’s true.

Very frankly, the law.

The medicare program has created a set of laws and perverse incentives to minimize or eliminate “purely private patients.”

What’s stopping you only taking purely private patients?

‘You seem to think that reducing funding to government programs that limit personal liberty is a step toward the free market’

No - I just see the cuts as just that - cuts in sorely needed government programmes.

‘The funding cuts are in fact a consequence of government meddling’

This nonsensical. We are talking about government programmes. They are theirs, or rather yours, to meddle with. It’s simply the case that your present president chooses to slash the funding.

‘But as long as my liberty, my ability to negotiate with individuals to provide a service for mutually acceptable compensation is shackled in the dungeon of well-meaning entitlement programs gone awry’

Just don’t do it then. You’re sounding rather pitiful. How much do your earn, anyway?

‘In the UK, is there any patient for which a physician is legally forbidden from accepting remuneration directly from the patient for services, at a rate negotiated strictly between the parties, and outside of governmetn regulation?’

Any private practitioner can do what they want. But most acute sector doctors are salaried employees who work in the NHS, and patients do not pay anything directly, bar a small charge for drugs if they do not qualify for free drugs (eg pregnant women, kids, low income). Many primary care doctors are self-employed and run their own practices, but solely under NHS contract. Some consultants work in both the NHS and have a private practice, subject to fulfilling their NHS contract.

I am not confused at all.

Remove the regulations that increase the cost of providing care to all patients, so I can negotiate with ALL of my patients, one on one. Then I can afford to provide a certain amount of charity care, reduced fee care, ability to pay care, or care in exchange for an apple pie, whatever.

‘There is now just less gov’t money.’

“That’s right! I see Bush is trying to force huge healthcare cuts in Medicare and Medicaid. So - do you support or oppose these cuts? This is a simple question. ”

I oppose them. I see that it is you who are confused. You seem to think that reducing funding to government programs that limit personal liberty is a step toward the free market, something a free market type such as myself would favor. This just demonstrates your lack of understanding. The funding cuts are in fact a consequence of government meddling that will result, much as it has already, in a shortage of providers. The reason I oppose the cuts is that I still have to live under the rules imposed by the system that is so financed.

Do I support abolishing these programs completely and all of the regulations that hinder my ability to negotiate with my patients for services? Yes. But as long as my liberty, my ability to negotiate with individuals to provide a service for mutually acceptable compensation is shackled in the dungeon of well-meaning entitlement programs gone awry, reductions in funding do no good. They do me no good as a physician, nor as a taxpayer, nor as a patient.

I have a query for you, out of curiosity: In the UK, is there any patient for which a physician is legally forbidden from accepting remuneration directly from the patient for services, at a rate negotiated strictly between the parties, and outside of governmetn regulation?

No one is talking about a market failure in this story.

‘Remove the regulations that hamstring providers and patients, and then remove the programs, and let the market do it’s thing.’

But you said yourself how would Medicaid patients pay their bills. You seem very confused by this.

‘There is now just less gov’t money.’

That’s right! I see Bush is trying to force huge healthcare cuts in Medicare and Medicaid. So - do you support or oppose these cuts? This is a simple question.

‘Proponents of universal insurance, mandates etc, should take note that in spite of these cuts, the same number of people are “covered.” Where and how they will find access to care, however, is another question.’

Under universal healthcare systems we also get resource planning to build facilities and recruit staff where they are needed. Hence we get access to care.

It’s easy to argue half a point, isn’t it?

Yes, I think the free market could devise better solutions (through free market evolution, not central planning) than medicare, medicaid. However, if practictioners are forbidden by law from engaging in free market activities (a la Medicare and Medicaid) then cutting the programs does NOT demonstrate a free market failure, it demonstartes a failure of government control and central planning.

Remove the regulations that hamstring providers and patients, and then remove the programs, and let the market do it’s thing. The reductions in funding did nothing to relieve providers of the restrictions that would allow them to negotiate directly with patients for their services. We are still bound by those restrictions, which are that we must take the gov’t money or none at all. There is now just less gov’t money.

Government funding is not the problem, government regultions and controls are.

Proponents of universal insurance, mandates etc, should take note that in spite of these cuts, the same number of people are “covered.” Where and how they will find access to care, however, is another question.

Well exactly. So what exactly is your beef here, if you agree that Medicare/aid is necessary? You and Stuart (and Catron) are making no sense at all. I would have thought you free market buckeroos would be cheering every cut in government funding to the rafters.

Marc suggests that there will always be a choice - really? how do you know? Do Medicare recipients have a choice? Do medicaid recipients have a choice? With what will they purchase private health insurance?