Beginning in January 1998, any doctor who treats even one senior citizen on a private basis will have to file an affidavit swearing that he or she will not treat any Medicare patients for two years. Those are the rules under the Medicare provisions of the recently passed budget.

What are the implications?

• Few doctors outside very wealthy communities will be able to comply -- so private contracts will be effectively impossible.

• Patients who want to avoid Medicare's regulations, rationing and restrictions will be unable to find a physician willing to treat them.

• Although nothing in Medicare prohibits patients from entering into private contracts with doctors, the sanction against doctors who do so effectively outlaws private services.

The Clinton White House insisted on a one-year prohibition against doctors treating both Medicare and private-pay patients in the budget agreement -- but it was lengthened to two years at the last minute.

Analysts warn that this poison pill effectively undermines the new medical savings account program. The MSA experiment allows 390,000 seniors to take out high-deductible health insurance policies, then pay for routine care out of tax-free savings accounts funded by the savings on the less expensive policy.

"The assault on the doctor-patient relationship is deliberately designed to make private contracts with Medicare patients all but impossible," says Robert Moffit, a former deputy assistant secretary at the Department of Health and Human Services.

Analysts point out that even elderly Britons covered by their National Health Service enjoy the right to "go private" and pay an NHS doctor for treatment outside the system, even though the doctor treats other NHS patients.

Source: Editorial, "Medicare Showstopper," Wall Street Journal, August 22, 1997.