David,
I say "No" all the time. And in fact I probably say it more than most everyone else. I too ignore 95% of requests from insurance companies and other junk requests. But, I cannot envision dropping Medicare. My patients are basically loyal but not that loyal. When the Medicare Advantage programs came out and I did not sign up for the Anthem one, I lost a number of patients. More and more I find the patients are very motivated to save money. At this point if I made such a major change in my practice, I think it would be financial suicide. The patients will go to others who continue to accept it. It needs to be a unified endeavor.
