Last night, I met a business owner who is very angry at Obama.

[alc]

6. medicare reimbursements are low

I know two doctors with private family practices who lose money on every medicare patient. But they want to provide the personal care they can give with their own practice. These are doctors who do not have a fancy lifestyle or much income from their practice (e.g. literally less income than they pay their insurance administrator and one skips her paycheck often to have enough money to pay her staff). They tell me you need to run a "production line" practice to not lose money from medicare. That means the doctor sees the patient for 8-10 minutes no matter what the problem then bring in the nurse or ship them off to a specialist.

The idea behind the limits on in-home care is that hospitals or doctors offices can run a production line cheaper than providers can do in-home care. So reimbursements have been cut more for in-home care. Sucks for in-home providers and those who really need in-home care but does reduce cost. We have a few years coming where providers and patients are going to need to adjust to the ACA (lower profit and less/costlier care).

I personally want to see the "we'll get you a free scooter" people go out of business and we develop an effective way for the "production line" doctors to get a scooter to anyone who really needs one. And a higher co-pay will get some people on the edge of needing one to pay a little more attention to their health rather than make their life easier with a scooter. I won't be getting medicare for 10+ years, and every wasted dollar now is less medicare money then. If the guy in the OP is gouging, then he needs to stop. Either way he needs to deal with it (become more efficient, go out of business, make less money)