The basic question is whether Medicare should prevent all beneficiaries from getting services they and their doctors think they should have when Medicare does not agree. The other justification is the flip side of the first. Thus, private contracting is all but prohibited to prevent the creation of a two-tiered health care system. Medicare restricts the freedom of patients and doctors in an effort to achieve an equality that is both futile and, in any event, beyond the proper role of the program. It is impossible to predict how patients and physicians would be distributed if private contracting were permitted.
Many factors determine who is cared for by what physician.
More fundamentally, the second justification assumes that Medicare should attempt to equalize the distribution of patients among physicians. Preventing beneficiaries from paying for services that Medicare finds unnecessary will prevent people who are able to pay for those services from getting more care than others who must rely on Medicare. It is not, however, the role of Medicare to prevent people from exercising their freedom to obtain care. Even if egalitarian distribution of care were an appropriate goal, moreover, the prohibition would not achieve that result. If beneficiaries are barred from obtaining the care they want here, some will go outside the United States to obtain those services.