Medicare Problems

To the Editor:—  It is unfortunate that Dr. Roth's otherwise comprehensive report (197:347, 1966) did not discuss a serious inequity in the provisions of Medicare which extends outpatient diagnostic services to beneficiaries under parts A and B, subject to a $20 deductible in hospital outpatient departments while charging a $50 deductible for the same services in the offices of private radiologists and pathologists. This is further aggravated by Blue Shield, Medicare-65 plans (as in New Jersey and Pennsylvania) which pay both the deductible and the 20% coinsurance only to the hospital outpatient departments and not to the private specialists. The bias of the law extends also to those covered under part A only, for they receive supplemental payments for x-ray and pathology examinations only in hospital outpatient departments and not in physicians' offices.Thus by economic pressure resulting from legislative decree, the government is directing patient referral in the