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MACRA/MIPS is the problem, individual health freedom is the answer


MACRA/MIPS should be abandoned for the good of Medicare patients.

Dear Congress & CMS,

The original stated goal of Medicare in 1965, to give healthcare to those at the end of life—when life expectancy was about 65 years—was credible and laudable. However forcing all citizens to participate in Medicare, and pay hard-earned dollars into a system that they don’t want to use is not laudable, especially given the expanding government interference in Medicare which exponentially increases under MACRA/MIPS.


Related: Small practices likely 'losers' under MACRA


The original 18-page legislation declared:

"Nothing in this title shall be construed to authorize any federal officer or employee to exercise any supervision or control over the practice of medicine, or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer, or employee, or any institution, agency or person providing health care services...."

Since 1965 every act of Congress and all CMS rules for Medicare have violated the original Medicare law. The latest iteration, MACRA/MIPS, is the last straw and breaks the camel's back of Medicare. 

It usurps all Medicare patient privacy by giving CMS, insurance companies, contractors and their designees unfettered access to all demographic and health data. This is a violation of the patient/physician relationship and nullifies any claimed health benefit effects. Further, it subjugates physicians to â€Å“composite scoresâ€Â based on arbitrary statistical calculations that have no bearing or merit for the individual patient. 


further reading: 7 things physicians need to know about MACRA proposed rule


Furthermore, even before the associated penalties are factored in, it is impossible for a solo- or small-practice physician to comply with the onerous financial costs to implement this data gathering and sharing.

Finally, MACRA/MIPS does nothing to improve the health of groups or individuals as initially intended, but only increases the cost of care, decreases its efficiency, and further takes the right to choose away from the patient. 

Next: Should be abandoned for the good of Medicare patients


MACRA/MIPS should be abandoned for the good of Medicare patients. Medicare should look at auto insurance for a better model. Policies are inexpensive and cover only major catastrophic losses, like that of major collisions. Day-to-day car needs like oil changes and buying gasoline are inexpensive because they are not covered. Similarly, the patient in a free market should pursue and pay for their own direct primary care or other relationship as they see fit. 

Auto insurance does not force you to get referrals for repairs or tell you that you have to buy gasoline from certain vendors within the network. Car owners pay the repair shop directly and then are reimbursed by their insurance company, making them better educated shoppers and consumers. Free-market competition among physicians, imaging centers, testing facilities, hospitals, and insurance companies, will produce a plethora of options and increase effectiveness and quality at decreased cost.


Related: MACRAnomics—a guide for physicians


Please reconsider MACRA/MIPS  as it is deleterious and dangerous to the health and welfare of all individual Americans forced to pay for it.  Medicare should be catastrophic coverage that is inexpensive, and only covers major losses. American patients should be free to pursue whatever care and insurance options they please and pay according to their own value system. 

Government Medicare currently forces patient debt and dependence. Government Medicare must inspire resiliency foster patient independence. 

If you have any questions please feel free to contact me for further references, plans and significant detail. 


Best wishes for good health,

Craig M. Wax, DO

Family Physician

National Physicians Council on Healthcare Policy member @NPCHCP

Host of Your Health Matters

Rowan Radio 89.7 WGLS FM


Twitter @drcraigwax 


For more info contact the National physicians council for healthcare policy: 


Make your comments to CMS on Regulations.gov prior to June 27, 2016 link to page:


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