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Your Voice: MACRA will be the death of Medicare


In regards to “Is MACRA Legal?” (, October 22, 2016), I agree that MACRA appears to violate the non-interference clause of the Medicare Act, as your editorialist pointed out. In addition, I would add that the 2,300-plus pages of rules and regulations which define MACRA constitute an oppressive burden on practicing physicians which will increase, rather than reduce, the cost of medical care. 

“Pay-for-performance” bonuses will eat up precious dollars which should be directed toward compensation of physicians for providing essential direct patient care. 

Fee-for-service compensation is the most fair, accurate and parsimonious way to reimburse physicians for patient care, which is why so many physicians who treat the elderly accept Medicare assignment. An elderly cancer patient with traditional Medicare plus a supplemental policy can make an appointment with an oncologist at a top institution and receive the best treatments available without having to lay out any additional money. 

I predict this will end soon under MACRA, and patients with traditional Medicare will be left with as little choice or autonomy as HMO patients currently have, perhaps even less. Doctors will flee the oppressive MACRA regime as soon as they can afford to do so, and eventually Medicare coverage may become as widely unwelcome in private practices as Medicaid currently is.

The only solution is to trash this absurdly complex and burdensome MACRA scheme, all 2,300 pages, and return to traditional fee-for-service Medicare, with compensation set at the lowest rate which will be accepted by enough physicians to make the system work. That will be the cheapest system possible, and the simplest. 

If an insufficient number of physicians participate, it is time to raise the fees paid for their services. Traditional fee-for-service Medicare is based on the free market, the only system which, historically, works for setting fair prices and distributing goods and services efficiently.

David L. Keller, MD

Lomita, California

Next: Docs who don’t understand guns are ‘moronic’


Docs who don’t understand guns are ‘moronic’

I find it disturbing that practicing physicians could be so superficial in their understanding of gun violence (“Guns in the medical practice,” September 25, 2016). 

If we are going to remove items that can be utilized to kill people then we will need to outlaw that other high speed metal that kills 30,000 people a year-cars-and don’t forget fertilizer and diesel fuel, knives, pressure cookers, etc. 

The fact of the matter is, focusing on the means used to kill is highly superficial, sophomoric and moronic-if someone wishes to kill they will. The issue is not the mechanism; the issue is a disturbed mind and the society that has generated that mind.

Not to understand this is indeed a great embarrassment for our profession and reveals a woeful absence of capability to peer into the depths of the human mind and soul, something our profession should at least have a modicum of experience with.  

M. Niziol, MD

Dryden, New York

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