Huh?  What's that and why does it matter?

Back when Congress and the American Public cared about having a balanced budget, a section of the 1997 Balanced Budget act was injected to allow high priced doctors to opt out of Medicare and not be subject to any price controls.  In return for that, it prohibits doctors from participating in Medicare for two years and treating any patient without the patient agreeing that the patient is 100% responsible for payment and that Medicare deemed the treatment unnecessary.   This "PRIVATE CONTRACTING" has created a under the radar type, of better quality healthcare available only to those that can and will pay for it.  

Medicare patients may have limited legal access to a private agreement with a physician only if the Medicare bureaucracy considers the particular service desired to be uncovered or "unnecessary" or potentially "unnecessary." If a medical service is "covered" by Medicare and is deemed "necessary" by the Medicare bureaucracy, then a Medicare patient may not contract privately with a doctor for it, even if that service is vital to improving health or quality of life or would be life-saving.  ( I better source that now:  For a discussion of Section 4507, see John S. Hoff, Medicare Private Contracting: Paternalism or Autonomy (Washington, D.C.: AEI Press, 1998); see also Robert E. Moffit, "How Congress Can Restore the Freedom of Senior Citizens to Make Private Agreements with Their Doctors," Heritage Foundation Backgrounder No. 1209, August 3, 1998. - http://www.heritage.org/Research/HealthCare/BG1347.cfm)

We believe that the middle class, which we define as 2x-5x the 2009 Federal Poverty Level, (for a single $21,660 annual income, to a family of four with $110,250) to be most severely impacted by a rationed healthcare plan.    This group of people will only get healthcare from the "public plan" and may not be able to pay for private healthcare.