Medicare rationing is more subtle. Physicians can restrict the number of Medicare enrollees they treat – seeing only those who are already patients. In addition, doctors may only schedule an appointment for Medicare patients if open time slots are not likely to be booked by better-paying patients. Another trend is many primary care providers are turning to concierge practice models.

A recent article advised people approaching Medicare eligibility to begin looking for a primary care doctor who takes Medicare at least one year in advance. This is likely to get worse as Congress cuts Medicare spending by $523 billion over the next 10 years and Baby Bookers begin retiring in droves.