Showing posts with label Can you trust the Feds with you health?. Show all posts
Showing posts with label Can you trust the Feds with you health?. Show all posts

Wednesday, April 9, 2014

We're All (Government) Workers Now

As part of being a doctor in this country, most of us are compelled to accept Medicare patients as a portion of our practice. If you want to work in a hospital, you have to accept the government health insurance plan for the elderly. Really the only people who can refuse it are the concierge and cash only physicians. If it weren't for these rules, I think many doctors would have opted out of accepting Medicare patients a long time ago due to the declining reimbursements and cumbersome bureaucracy.

Now that we've made a pact with this devil, the devil has turned around and stabbed his pitchfork right back at us. Medicare today released its database of payments it has made to over 800,000 doctors in 2012. For years this information on physician income was kept private under court order. But thanks to heavy handed lobbying by trial lawyers and consumers groups, Medicare was ordered to open up this data, all in the name of detecting and prosecuting fraudulent doctors who are supposedly milking the system dry.

It is galling that doctors have fallen so far in society's esteem that this most private of information can be forced into view for public consumption and criticism. We are now essentially public contractors who to take care of the government's healthcare obligations yet we don't get the same privacy protection that other government workers receive. Is there a database for the salaries of the people who work at NASA? Or how about the CIA and the FBI? And I want their names and places of residence too.

Still this information can also be quite entertaining. It will probably be used more by your fellow physicians than your patients or their lawyers. It is actually kind of fun to browse through and see how much money your colleagues made off of Medicare two years ago. You can search by name, specialty, and location. For instance the top three anesthesiologists in California each received over $1 million from Medicare. I found out that I didn't even make it into the top 100 best reimbursed anesthesiologists. I guess that proves that I'm not defrauding our government? And don't even think about comparing your Medicare payments to the gastroenterologists or ophthalmologists. With all the colonoscopies and cataract surgeries those people perform, they are the ones who are really raking in the big bucks from the Feds.

So fellow doctors, we accepted this contract with the federal government nearly fifty years ago to help the elderly in this country with their healthcare. Now this is the gratitude that we have received. Along with declining payments and waffling on the fix for the SGR, how much more can they do to repel doctors from accepting anymore Medicare patients?

Tuesday, November 27, 2012

My State's Legislators Are Getting Feted In Hawaii While I'm Buying My Pens From Costco

I've finally used up the last of my stash. After years of accumulating drug rep pens, I have finally run out. They have all been used or the ink has dried up inside so they won't write. Well it was fun while it lasted. I remember the good old days when the salesmen from the pharmaceutical companies would bring breakfasts or lunches to the doctor's lounge. For five minutes of my divided attention I could get a nice pasta or baked chicken lunch while getting educated on the advantages of their latest product offerings. Of course I would try to grab a few pens and notepads on the way out.

This was all strictly educational of course. I had no control over what kind of drugs I could use. That was controlled by the hospital pharmacy. I decided in the operating room which drugs were best for my patients, not what the drug rep told me was the best on the market. I'm not so greedy as to use medications just because somebody bought me a sesame bagel with a large schmear of lox for breakfast.

But a a few years ago our wise politicians decided that doctors were being bribed by drug companies into prescribing expensive meds. They believed this was the reason healthcare costs were rising at unsustainable rates. How can doctors possibly not be affected by all the free gifts that were being showered on us? Who couldn't resist the sales pitches of these oily drug reps as they try to push the latest antibiotics and antihypertensives on us poor helpless physicians? Therefore doctors and hospitals pretty much succumbed to political pressure and bad P.R. and stopped accepting gifts of all kinds, even from grateful patients and families. Now I use scratch paper from the back side of junk faxes and buy my own pens from Costco.

On the other hand, the politicians themselves don't seem to have any second thoughts about receiving presents from the myriad of lobbyists that surround them every day. Even though the election is not even a month old, our good old California elected officials are already grabbing at every freebie they can get their pudgy little hands on. The LA Times reported on a group of newly elected state representatives enjoying a basketball game together in AT&T's luxury box in Sacramento. Says Jose Medina, assemblyman from Riverside, hobnobbing with lobbyists is "part of my job. At the end of the day I'll make my decisions based on what is best for the people I represent." I'm sure the free food and drinks in the luxury suite will have absolutely no bearing on how he votes.

Then there is the group who jetted out to Maui after the election for a five day "conference" on matters important to Californians. The trip was sponsored by a tobacco company, various drug companies, utility companies, and state public workers' unions. As one freshman representative tried to rationalize his reason for flying to Hawaii to learn about California's many problems, "I was learning about the issues. There were some things I didn't know--such as how businesses really need help to flourish here in California." Others flew as far away as Brazil, Australia, and China, on lobbyists' expense, to gain insight on how to help the people who just elected them.

The hypocrisy would be laugh out loud funny if it wasn't so disheartening. Politicians accuse doctors of not being able to tuck a few cheap pens into our pockets without being influenced into prescribing expensive drugs while they have no qualms about accepting tickets and hotel rooms to exotic locales from lobbyists in the name of education. I feel gypped. If I have to accept Obamacare and its impending reimbursement cuts, at least let us have our old pens and notepads back.

Thursday, August 20, 2009

Can you trust the Feds with your health?


The federal government has announced that the Cash for Clunkers program is going to end on Monday. Is that a surprise? When the program first started in July with $1 billion, it was supposed to run until November 1st. Of course whenever you give away free money people will want it. So the money ran out in about one week. Obama and Congress, in their generous Santa in summer mode, gave an additional $2 billion. This was supposed to last until Labor Day. Well that prediction was wrong too.

So many things have gone wrong with this. First, the feds don't know how to predict demand for a product (money) that is being given away for free. Second, they don't know how to implement this program. Dealers have stopped accepting trade ins because the government is not able to process all these applications quickly enough to reimburse the dealers. Thus the dealers are out thousands of dollars until the feds get their act together. Third they ran out of cars to sell. With free money, so many people wanted cars that the infrastructure was not able to handle the crush of demand. Now there is very little choice of products for these customers.

Now take those three conditions and you can apply them almost directly to the planned government takeover of health care in this country. When the Medicare prescription drug benefit was passed in 2003, the ten year cost was predicted, and propagated by the politicians, to be $400 billion. Only ONE year later, the cost was raised to $500 billion. And you think you can trust Congress to make the cost of health care revenue-neutral? Inevitably there will be higher (much higher) taxes, lower reimbursements, and restrictions on care to keep health care costs from devouring our economy.

The government can barely run Medicare now without severe delays in reimbursement. Doctor's operating margins are already thin. The physician usually has to pay himself last behind all his staff, rent, taxes, utilities, vendors, etc. If we suddenly have a mob of new patients with government insurance and reimbursement slows, who do you think will eat the cost? This would be the end of the romanticized small practice primary care doctors that are so beloved by the public.

Finally, demand for services would be enormous. You can already read about the long waits and denial of services common in countries with socialized medicine like Canada and Europe. Remember what the Canadian Supreme Court ruled--access to a waiting line is not access to health care.

So while universal health coverage for Americans is commendable, a government implementation would be problematic. This Cash for Clunkers program clearly demonstrates the pitfalls that would await us all if the government takes over our health care.