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By the time you read this, the largest expansion of a taxpayer-funded medical entitlement will have occurred. It is one that will drive several more nails into the coffin of what used to be the best free-market health-care system the world has ever known.

Lawmakers, with usual Orwellian doublespeak, are calling the gargantuan expansion of Medicare, via a brand-new prescription-drug “benefit,” a massive “reform” effort that was long overdue. And while most people can agree reform was overdue – especially those in the health-care industry – there is much less “reform” than “entitlement” in this new behemoth.

For one thing, the bill for this new benefit is vastly expensive at a projected $400 billion over 10 years, but even that gigantic figure is misleading. The original Medicare plan, when it was introduced 38 years ago, was projected to cost tens of billions of dollars less than it actually has. So to accept the $400 billion figure at face value would be akin to believing health-care costs won’t continue to soar, that gold is buried beneath the Florida Everglades, and that Bush Republicans really are committed to smaller government.

For another, there is little in this bill that returns the health-care industry to the kind of free-market competitive model needed to corral patient-care costs which include, ironically, prescription drugs. There will be token competition between Medicare and private insurers, but it is little more than that, say health-care analysts. The government is still making the rules, and as long as that happens, there can be no real “reform.”

See if this vicious Medicare circle has a ring of familiarity. When Washington has a few bad fiscal years and can no longer afford to pay the prices asked by providers of health-care services, the government will do what it has always done: It will simply cut back on those payments, leaving doctors and hospitals in the financial lurch. In exchange, those providers will have to raise prices in order to make up for their losses, which means additional costs the government still won’t cover. This is what has been going on with Medicare for years.

“We had high hopes for the opportunity to start to restructure the crumbling Medicare with free-market protections, cost controls, and patient choice that are available to those under the age of 65,” says Dr. Jane Orient, M.D., executive director of the American Association of Physicians and Surgeons, a group of doctors opposed to further expansion of Medicare. “But we cannot support a reckless, open-ended entitlement in exchange for a token demonstration project and hollow promise of regulatory reform. Both may be doomed to failure by design.”

She knows of what she speaks. Her organization just completed a survey showing that, in the not-too-distant future, more of her colleagues will be bailing out of Medicare while those who remain will accept fewer new patients, if any, because of the continued regulatory and cost burdens associated with the program. The end result, doctors believe, will be rationing – rationing – of remaining health-care services for the elderly.

It gets worse. The survey’s results “show that increased government involvement in Medicare is actually responsible for increasing physician demoralization and practice changes that are making it tougher for patients to find doctors who are willing to treat them,” says AAPS. “And the impact is being felt by all patients, not just seniors, and will get worse if an open-ended, costly drug benefit is added.”

Interestingly, money is not entirely the issue. Of the 344 doctors who participated in the survey, most said they “would rather treat uninsured patients, possibly for free, than jump through Medicare hoops,” according to AAPS’ Kathryn Serkes.

Senate Majority Leader Bill Frist, a physician by trade, should know this. Instead, he is being praised by mainstream Republican cadres for his “leadership” in getting the prescription-drug benefit pushed through for President Bush. Either Frist has been out of private practice too long or he purposely ignored Medicare’s cumbersome regulatory burden and poor doctor-hospital reimbursement record to score political favor. Either way, Frist, this Congress and this president have sentenced future generations of older Americans to limited health-care options that inevitably will be more expensive.

Anyone who believes this 1,000-plus page “reform” bill will slim down Medicare costs and bureaucracy needs more than a psychological exam. They need a course in Medicare 101.

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