Dr. Sam Online

Okay, the following is a totally political rant. If you aren’t interested in a bunch of political ranting about socialized medicine, or the problems with Medicare funding, etc, (which, by the way is probably indicative of sanity and common sense on your part) then you should probably skip this post as it will most likely just irritate you. There is nothing in it that is informative about any particular medical topic or anything. It is not categorized under the “How to stay healthy” or “Silly Fun Stuff” categories for a reason. Disclaimer over with now. If you read further, don’t say you weren’t warned.

The “Medicare: Stop the Cut” campaign is more of the “Same Song Different Verse” routine, courtesy of the American Academy of Family Physicians (AAFP).

The wonderful Medicare program, which proponents of universal government health-care point to as their shining example of what should be done for the entire population, is once again on the brink of sharp reductions in reimbursement to physicians, and the AAFP is once again rallying the troops, urging everyone to write their congressman and avert this looming disaster.

You can read the AAFP’s latest (well-meaning, but in my opinion misguided) opinions on this here and here.

I have very mixed feelings about all this mess.

On the one hand, as a family physician who is “In the trenches”, I fully support the AAFP position on trying to avert this drastic cut in Medicare reimbursement.

They are absolutely right that in the short run, this cut would be fairly disastrous regarding access to care for the Medicare population, rapidly accelerating an already precipitous fall in such access. Also, on a personal note, it affects my wallet directly.

On the other hand however, I think that in a broader philosophical long-range-vision way, the AAFP is totally missing the boat here. To paraphrase an old saying my dad used a lot when I was a kid growing up (which I think he must have picked up during his days in the U.S. Navy), they’re “Stomping on piss-ants, while elephants are thundering by.”

I’m sure that this current crisis, just like all the past ones will go right down to the wire. At the very last moment, Congress will pass some sort of emergency measure putting the drastic cuts on hold for another 6 months or a year or whatever. They might even, as in past episodes, temporarily increase reimbursement by half a percentage point or so.

The AAFP will claim victory and proclaim themselves as heroes and send emails to all the academy members so that they will all be convinced of just how important AAFP membership is and keep sending in those dues payments.

Then six months or a year later, we can repeat the whole darned process again.

So, every six months or so, Medicare reimbursements go up a half-percent or so, meanwhile inflation keeps jacking up prices for everything by at least 4-5% a year…

…meanwhile, the Medicare program keeps adding new increasingly ambiguous and confusing rules and regulations to physicians which all add significantly to the cost of doing business and increase significantly a physicians likelihood of facing prosecution for charges of Medicare fraud, should he or she accidentally file some form incorrectly…

…meanwhile other entities such as OSHA and JCAHO keep adding their own new ambiguous rules and regulations which all add significantly to the cost of doing business and similarly increase the chances of prosecution…

…meanwhile, other costs associated with running a medical practice (like medical malpractice insurance, for instance) continue to skyrocket…

…and pretty soon it’s time to call George Clooney and Mark Wahlberg to see if they’re interested in staring in this sequel to “The Perfect Storm.”

Unfortunately, just like the “Andrea Gail“, the Medicare system, and in fact the entire U.S. health-care system is sinking fast. The hull is breached and filling with water, and stopping this Medicare pay cut is like trying to bail it out with a Dixie cup.

In that article linked to above, here’s the quote that stood out to me. “I strongly doubt family physicians would turn away Medicare patients they are taking care of right now,” said AAFP President Jim King, M.D., of Selmer, Tenn., in an interview with AAFP News Now. “But we do know that many practices are closing their doors to new Medicare patients because they simply can’t keep their practices open due to low payments.”

Of course medical practices are increasingly closing their doors to new medicare patients. Of course they can’t afford to stay in business continuing to see these folks.

Here’s the thing Dr. King, some practices in fact are being forced to turn away current Medicare patients. They aren’t simply declining to take on new Medicare patients, they are being forced to quit seeing the ones they already have. The number of physicians completely dropping out of the Medicare program is growing rapidly.

Dr. King, I appreciate the position you are in, but do you really think another “Hey AAFP members we averted a 10% cut in reimbursement…and managed to even get a slight increase in reimbursement that almost equals a small fraction of the rate of inflation!” is going to convince these folks to rejoin the Medicare program or convince others who are contemplating dropping out to change their mind?

I get it. You guys at AAFP are fighting for all of us lowly members. You’re standing up to the politicians who want to cut Medicare reimbursements, yadda, yadda, yadda. You’re trying to keep physicians from dropping out of the Medicare program and further decreasing access to care for Medicare patients.

Here’s the thing….Medicare is doomed! It’s broken! It doesn’t work! It is a vastly bloated bureaucracy that does more harm to the nations health-care than good. The sooner it’s put out of it’s (our) misery, the better. It’s not about the money, Dr. King. Averting the looming cut in reimbursement does not address the underlying problems. It does not address the fundamental problems with the system and the real reasons physicians are bolting from the program.

Medicare’s days are numbered. Averting another funding cut does nothing but delay the inevitable. In doctor talk, it’s like pulling off a band-aid slowly, rather than just yanking that sucker off.

It’s really no wonder more and more doctors are dropping out of the program. The program stinks. It is filled with Draconian rules, has a totally prosecutorial attitude toward honest mistakes folks make in trying to comply with those confusing rules, and increasingly costs physicians more money and more headaches to participate.

In a nutshell, it’s an overbearing monster that simply gets in the way. It prevents physicians from practicing high quality medicine in the fashion that they have been trained to do. It tells physicians, “Now that you’ve been through years of training and hard work honing your skills, we’re here from the government to tightly control everything you do and keep you in line. We don’t trust you. We are hear to make sure you don’t screw up and to keep you honest and to put you in jail if we decide you aren’t.”

But, as I said, Dr. King, I get where you are coming from. To paraphrase Donald Rumsfeld, you don’t go to war with the Medicare system you want, you go to war with the Medicare system you have.

Here’s where I have a major problem with the AAFP however. I attended the AAFP Scientific Assembly in Washington D.C. in fall of 2006. During the opening ceremonies, I heard speaker after speaker from the AAFP strongly call for government run and mandated universal health-care for all. There was a cornucopia of self-congratulatory platitudes emanating from these speakers towards one another. I was appalled. I felt almost as though they expected me to pull out and wave my little red book or something. The one sort of sensible speaker in the whole ceremony was the guest keynote speaker, Newt Gingrich.

The only thing that gave me any hope at all….the only thing that prevented me from aborting my AAFP membership immediately…was the response I observed from my fellow audience members (composed mostly of regular practicing physicians like myself), which was overwhelmingly non-applause and low grumbling every time one of these pie-in-the-sky ivory tower organized medicine types blurted out one of these sound-bites straight from the Communist….er, I mean Democratic…..party platform.

Dr. King, I still haven’t quite given up on the AAFP, but I’m leaning. I’m getting mighty tempted to quit sending my dues payments in to you guys. I’m getting mighty tempted to instead use them to join some other organization, perhaps the Association of American Physicians and Surgeons.

U.S. Government run health-care is a disaster. Medicare is a disaster. Medicaid is a disaster. Medical care in the VA system is a disaster. Medical care at Walter Reed Army Hospital is a disaster. I’m not going to engage in the argument about how wonderfully health-care is run by governments is all the rest of the world. Maybe it is, I don’t know. I have however been fairly well exposed to how well health-care is run by the U.S. Government in those realms where it does run the show, and my verdict is “It stinks!”

None of this means that I think all the folks working in these various entities are bad people or bad doctors or aren’t well intentioned or anything of the sort.

Many, if not most of these folks are well intentioned hard working people who are simply working within a broken system.

Our government had tremendous difficulty delivering a few bottles of water to folks trapped in the Super-dome after Hurricane Katrina. Why are we all so eager then, for that same government to completely take over the nations health-care system?

Here’s where I see this going….and it ain’t pretty folks.

As elaborated upon above, this latest crisis, as with previous ones will go right down to the wire and the AAFP will save the day. More physicians will drop out of the AAFP and the Medicare program. The cycle will continue repeatedly. (By the way, this is a rant against the AAFP, but they are by no means the only culprit. The AMA is, in my opinion, every bit as misguided, and perhaps more so.)

Eventually, very few doctors will be willing to accept new Medicare patients and increasing numbers will drop the Medicare patients they have.

The U.S. population will continue to age as the “Baby-boomers” all get older. Since people are automatically enrolled in the Medicare program at age 65, whether they want to be or not, that means that a greater and greater percentage of the population will become Medicare patients.

So fewer and fewer doctors will be available to see more and more patients who are all entering the time of their lives when they will need the most health-care.

You think there’s a crisis now? Ha! Just wait a few years!

So, what will happen next?

Well, the folks on the political left, who contrary to their own propaganda, fairly well control the mainstream media, will go into overdrive with their message about how all these doctors are just greedy and aren’t doing their jobs….aren’t abiding by their Hippocratic Oath…are abandoning their poor frail elderly patients, etc.

I can just hear President Hillary Clinton, or Obama or Edwards (or whoever) now, “If the doctors can’t be trusted to do their duty and do the right thing on their own, if they are willing to abandon their patients this way simply because of greed, then the government will have to step in and force them to do the right thing.”

Hello, socialized medicine!

The populace will be forced to be patients in the system, and physicians will be forced to work within this system. They will be forced to accept whatever bureaucratic garbage Washington chooses to throw at them. They will be forced to accept whatever the government decides they are allowed to earn. They will have no authority to say how they wish to run their medical practices, but will be fully accountable for the crappy results that will inevitably occur.

More and more physicians will choose to retire early. More and more potential high quality medical students will choose other careers. The quality of medical school applicants and therefore physicians will go down. The profession will become overwhelmingly populated with so-so doctors (folks without even enough backbone to say “I have no desire to be a slave to the government.”).

Overall, the level of medical care in the U.S. will go down the tubes. All the cronies of the politicians will make a killing as they run businesses that get fat government contracts to manage the system.

Then, everyone will scratch their chins and wonder what the heck happened. A big government committee will be formed to investigate things and will come to the conclusion that what we need is some more bureaucracy and a few more government programs.

Ugh!!!!

Dr. King, please, continue to fight against the big 10% medicare reduction. I need the cash. Thank you for all your efforts on my behalf and on behalf of the medicare population.

When you are done with this latest fight however, will you please devote some of the AAFP’s efforts towards fixing the big problems rather than getting ready for the next “piss-ant” that will come along in 6 months. Really, in the short run I’d like to make a decent living, but even more so, I want in the long run for our nations health-care system to thrive and be able to provide the highest quality care to the greatest number of people

Could you please quit exhorting me to keep sending in my AAFP dues while simultaneously trying to put some sort of guilt trip on me if I reject this notion that people have a “Right” to free health-care.

My name is neither Cosmas nor Damian. My name is Sam. I am a physician. I practice medicine for a living. I am not a saint and I have no desire to be a slave to the AAFP, the U.S. Government or to anyone else who would lay claim to my livelihood as their “Right” or my professional status as their personal chattel.

If I feel a personal duty to provide charity care (which I do by the way), then I will do so. I don’t need you or the government or any other entity to come along and force me to do so. If someone else does not feel this personal duty, they too should be free to make their own decisions.

I think a quote which fairly well sums up the feelings which many practicing physicians have on this matter, can be found in the novel, Atlas Shrugged, written by Ayn Rand.

Dr King, rather than just focusing on some shiny pieces of silver and on perpetuating a broken system, could you and the AAFP concentrate perhaps on getting Medicare, and Medicaid, and OSHA, and JCAHO, and the DEA, and the insurance companies, and the trial lawyers, and big pharma, and organized medicine etc,…in short all those bureaucratic parasites who have nothing at all to do with actually taking care of patients, but are rather just leaching off the system……could you work on getting all these clowns out of my damn exam room!

It’s getting crowded in here and there isn’t much room for me or my patients anymore.