The Beginning Of The End

This was going to have to happen eventually. Anesthesiologists in Ventura County, CA, just west of Los Angeles, have decided that they are no longer going to work for below market rate wages. According to the Ventura County Star, anesthesiology groups who work at St. John's Regional Medical Center in Oxnard, St. John's Pleasant Valley Hospital in Camarillo, and Los Robles Hospital and Medical Center in Thousand Oaks have refused to work with Gold Coast Health Plans, which runs the Medi-Cal program in Ventura County. Medi-Cal is California's version of the federal Medicaid health insurance for the poor.

Medi-Cal already has one of the lowest physician reimbursements in the nation. According to one study, an anesthesiologist will get $180 for a one hour C-section and $190 for a two hour hysterectomy. This is not enough to cover the overhead expenses. Medi-Cal patients who want elective procedures done at those hospitals are referred to other facilities where the anesthesiologists will still accept the insurance. A director at one of the regional clinics recalled a patient who had to shell out $550 in cash out of pocket in order to get a hysterectomy at St. John's. According to Denise Templin, "She went with a checkbook and paid out of pocket. She got money from her family and stuff to help. It's just wrong. No one should be put in a position like that."

Oh really? Nobody should be put in a position to do what, pay for a service they want? When the going rate for anesthesia services is $550 and the insurance is only willing to pay $190 but the patient expects to pay nothing so the service is denied, is that truly unfair to the patient or the doctor? What did California Governor Jerry Brown think was going to happen when he petitioned, and got approval, for a ten percent cut in Medi-Cal reimbursements to doctors last month? Does the government just expect doctors to accept the slashing of their livelihood without protest?

Since this is America, the land of the caring, we doctors will still treat emergency cases for almost next to nothing, out of compassion and the law. Nobody will be turned away from the ER who truly has a life threatening medical issue. Try asking a lawyer or an electrician to work for free in an emergency situation. They would be more likely to double their rates for waking them up in the middle of the night, if you can find them at all. But doctors are demonized for complaining about being forced to take on charity cases or asking patients for payments for services rendered.

The most frightening part of all this is that this scenario will soon play out across the entire country if ObamaCare becomes the law of the land. We'll suddenly have millions of patients, many who can pay for health insurance but won't because their iPads are more important than their health, seek medical care with Medicaid level payments. Hopefully by this time next year the U.S. Supreme Court will have given us a clear answer to the future of medicine in America.