I blog about free markets in medical care and transparent pricing.


Nothing Makes Money Like a Mandate!

Quoting Jimmy Fallon:  "It’s amazing what you can achieve when you make something mandatory and fine people if they don’t do it and then keep extending the deadline for months."

I’ve relayed this story before but the resignation of Kathleen Sibelius commands me to tell it again.  Years ago I used points on a credit card to upgrade to first class only to find myself sitting next to a very sharp dressed professional woman.  I asked her what she did and she proudly stated that she provided consultant services to manufacturing companies, assisting them with their compliance pertaining to the rules and regulations issued by the Consumer Products Safety Commission.

I then asked her what she did prior to this consultant gig, wondering how she got into this business, to which she replied:

"I was Chairman of the Consumer Products Safety Commission."  I laughed out loud, subsequently making for a very quiet flight, this ex-bureaucrat not appreciating my sense of humor.  This individual had essentially created a demand for her services at gunpoint, issuing regulations, the compliance with which was later possible, only with her "assistance."

I see this same strategy when the head of the Centers for Disease Control, after mandating controversial vaccines, resigns, only to become the CEO of the vaccine manufacturer, the direct beneficiary of the CDC mandates.  You would think these people would take a sabbatical or save some tortoises or do some community service for a year so they wouldn’t be so obvious.  Al Gore and the global warming crowd, former joint chiefs of staff and their defense contractor pals, big pharma and the FDA….there is no end to this graft.

What will Kathleen Sibelius do now?  Will she go on a paid lecture circuit as the expert on complying with the Unaffordable Care Act?  Will she go to work for one of the cronies benefitting from the Obamacare scam?  Or will she hang up her spurs and retire in disgrace as the hatchet-woman of healthcare, happy to have destroyed the affordability of health insurance for millions and having snatched away the insurance so many more millions were happy with?  

While she was likely just a tool, she is nevertheless an accomplice and accessory to the crony crime we now know as Obamacare.  If she is like most of the rest of the departing D.C. offal, she has already arranged her soft landing, a high-paid sinecure funded by the folks who have directly benefitted from her crimes.  

My default position is to assume the worst from people like this, however, always hoping that whatever good is in these people will someday show itself in the form of an apology and remorse for the violence they have inflicted on the rest of us.  While Sibelius will not likely take this path, I will watch and hope that she will redeem herself by repudiating all that she has done and professionally all that she has been.  

Let’s watch what she does next.  Unfortunately, it will likely be the manifestation of the payoff for her innumerable lies and the “wet work” done to benefit the health care cronies.

G. Keith Smith, M.D.

For more information on free market health care visit:


Phil Cross, Fox25 OKC, Delivers Our Good News

Investigative reporter Phil Cross, whose beat is government waste, delivers here the good news to the taxpayers our pricing represents.  Hats off to Phil for this fine production and to the local Fox affiliate for airing this piece.  I encourage you to listen carefully to the comments of my good friend Jonathan Small, as his efficient speech contains dense and substantive information not to be missed.

G. Keith Smith, M.D.

For more information on free market health care visit:


Central Planning Gets McGuigan’s Flamethrower

Writing here for the Oklahoma Council of Public Affairs, Patrick McGuigan discusses the historic arrangement between our facility and Oklahoma County and the early success.  In a related article here, McGuigan, writing for “Capitol Beat” reports on the national attention and reaction to the success of our arrangement with Oklahoma County.  

Pat is a gifted writer and helps drive home the fact that while the government promises of affordable care have not only not materialized, these same promises are now widely thought of as bold lies.  His delivery also highlights the fact that the free market principles decried by statists and their cronies (and angrily dismissed by academics) are actually delivering real savings in health care delivery.  

Many thanks, once again, to Pat for sharing his writing gift with us and to those agreeing to quotes in the second piece to which I linked.  Statist central planning in general has received in these two articles the well-deserved flame-thrower of Pat’s “mighty pen.”

G. Keith Smith, M.D.

For more information about free market health care visit:


Two of our secret weapons: Brad Riggan and Andrew Harris

While a link to this video is present on our website, I would like to highlight once again the video produced for us by Brad Riggan and Andrew Harris, principals of Liquid Media.  The purpose of this video was to give the reluctant “medical tourist” a better feel for what our facility actually looked like and what we were all about.  

Patients from all over the country travel to Oklahoma City now for their surgery, confident (in no small part) that their destination is not only fairly and transparently priced, but unsurpassed in quality.  Hats off once again to the extremely creative and talented pair at Liquid Media, also the brains behind our current website design.

G. Keith Smith, M.D.

For more information on free market health care visit:


Our Deal With OK County on KWTV, local CBS station

Here, Alex Cameron of KWTV discusses with the legendary journalist Patrick McGuigan our unique arrangement with Oklahoma County, one which as I have previously written, has saved the County’s health plan $140,000 (it is actually more than this) in the first three weeks of the contract.

While McGuigan, normally quite reserved, finds the savings we are bringing to individual patients and private sector health care stunning, he couldn’t help but laugh out loud when I told him about the great early results we have had with our County arrangement.  If it looks like Pat is enjoying relaying this story as you watch the video clip, well….he is.  

G. Keith Smith, M.D.

For more information about free market health care visit:


Oklahoma County Taxpayers Receive a $140,000 Gift from Surgery Center of Oklahoma

Jon Wilkerson, Director of Human Resources/Benefits of the largest county in Oklahoma (Oklahoma County) bravely proposed to the elected officials of Oklahoma County that they enter into a direct contract with Surgery Center of Oklahoma.  Aware of the experiences other self-funded companies have had with whom we have these arrangements, Jon hoped that the County’s self-funded health plan could be spared the outrageous charges for outpatient surgical procedures to which the health plan had been previously exposed.  

Three weeks following County’s decision to accept Jon’s recommendation he delivered the results of this decision:  a net savings of $140,000.  County had paid us about $58,000 for surgeries that would previously have cost County $200,000.  The significance of these results, beyond the actual amount saved, requires comment.  

As far as I know this arrangement is the first of its kind, where a public entity has abandoned the corporate healthcare syndicate to secure guaranteed and transparent pricing directly.  It was not The Unaffordable Care Act, it was not price control dictates, it was not central planning that brought these savings to Oklahoma County’s health plan.  The savings resulted from the application of the principles of the free market to our medical practice, with the pricing and quality that predictably result when market forces are trusted and allowed to work their magic.

On another level I feel personally vindicated because for many years I have told state legislators that unlike corporate healthcare, I wanted no part of their favors, asking only to be left alone.  I have for many years assured lawmakers (many of which were determined to legislate our surgery center out of business in favor of their hospital pals) that if they left us alone, allowed to bring market principles to healthcare delivery, everyone would realize an improvement in quality and a lowering of prices.  To their credit, over the years enough of the state lawmakers in Oklahoma have resisted pressure from corporate healthcare to hamstring our efforts, allowing us to deliver the results promised.  

To a legislator, it is one thing to hear the praise heaped on us by a large self-funded company spared corporate healthcare’s pricing.  It is another matter altogether for a public entity to realize the savings many private self-funded companies now enjoy due to our guaranteed pricing, as obviously this public savings interests the lawmaker much more than any private savings.  Indeed, any future legislative push to hamstring the operation of our facility (like we have seen in the past) would now be seen as an attack on the interests and finances of Oklahoma County.

The elected officials (and the taxpayers) of Oklahoma County aren’t the only ones toasting Jon Wilkerson.  The employees of Oklahoma County, joking about Jon wearing a cape and an “S” on his chest, are also celebrating, as they now have a direct line to the fine physicians and surgeons on our staff and have been relieved of the outrageous copays previously demanded from them when they required surgery. 

While we have been contracting with self-funded companies for years now, the arrangement with Oklahoma County has definitely “hit a nerve.”  I will relay the reactions in my next blogs.

G. Keith Smith, M.D.

For more information on free market healthcare visit:


Obamacare, ethanol gasoline and cock fights

It is getting more and more difficult to find gasoline without ethanol, even though the demand for the more efficiently burning pure gasoline remains strong.  Central planners have decided to remove to some degree this choice from individuals.  That’s what central planners do, always justifying their tyranny with our wellbeing.  Behind the curtain, money is changing hands faster than at a third world cock fight, between the planners and those cronies who benefit from interfering with the natural choices of individuals.

I think about Obamacare whenever I can’t find 100% pure gasoline. Obamacare prohibits the purchase of the health insurance policies people want forcing the purchase of the ones the government wants us to have, ostensibly because the ones we want  aren’t good for us.  All the while, money is changing hands faster than at a third world….ok…I already said that.

This is the nature of government, isn’t it?  If we let people exercise their own free will, buying what they want to buy without interference, then all the folks willing to bribe their legislator wouldn’t do so well, would they? Perhaps fewer folks would want to become legislators!  

Someone who has been supportive of our business model at the surgery center asked me on a social media site recently, “what’s wrong with making everyone have health insurance?”  I don’t think I ought to make anyone do anything.  If someone thinks it is a good thing for them, they will do it on their own without anyone making them.  What this person really unintentionally meant was, “I believe people should be forced to accept the decisions of those who claim to know best,” notwithstanding the massive evidence that the pockets of these “all-knowers” and do-gooders are being lined by those who lobby for this or that mandate. 

Obamacare represents an interference in individual choice, plain and simple. In addition to your inability to decline health insurance, you must also buy an “approved” plan, not one that fits your needs.  I prefer the free market, not so much because it results in the best allocation of resources, but simply because like the vast majority of people, I wish to be free.

G. Keith Smith, M.D.

Dan O’Connor Writes with a Sledgehammer

Dan O’Connor, editor in chief of “Outpatient Surgery” magazine has written yet another stinging article, one he has kindly allowed me to post on my blog…sorry about the disjointed format.  Important definitions:  ASC, ambulatory surgery center, typically physician-controlled.  HOPD, Hospital Outpatient Departments.

The industry suffers every time an ASC is converted to an HOPD.

Last month in Springfield, Ill., ophthalmologist Sandra Yeh, MD, did what a growing number of ASC physician-owners are doing these days:

She sold out to the local hospital. Boy, did she. Dr. Yeh sold Prairie Surgery Center to St. John’s

Hospital for a cool $8.5 million. Dr. Yeh paid $3 million to build and equip the center 3 years ago. Not only did she flip her ASC for nearly 3 times what she paid for it, but she’ll continue cashing the hospital’s checks.

St. John’s will lease from Dr. Yeh the building in which the surgery center operates. The hospital will hire 19 of Dr. Yeh’s employees who staff the surgery center and offer them signing bonuses of $500 to $2,500. Best of all, Dr. Yeh will continue doing sur- gery and running the facility under a management contract with St. John’s. She’s not boasting when she tells you that she can do 20 8-minute cataract cases by noon. “I do great surgery, have happy patients and make a profit,” she says. “There’s noth- ing wrong with that.”

St. John’s made Dr. Yeh, 51, an offer she couldn’t refuse. The burden of running an ASC was getting to

her: the growing disparity in Medicare’s payment rates, slow-paying payors, increasing reporting require- ments, EMRs, ICD-10. “ASCs are paid 47% less than the hospital,” she says. “You can’t throw a thousand- pound weight on a horse and expect it to jump a wall.”

Plus, she knows St. John’s. She worked for 20 happy years at the hospital. Three years ago, things changed. Cataract patients were forced to wait 11 weeks to get on the schedule. A disruptive renovation project. An interim CEO who wanted to phase out ophthalmology and all but showed Dr. Yeh the door.

“When I left there, I knew they were making a mis- take,” she says. “You can’t hide the exit of 1,200 cases.”

We can’t fault Dr. Yeh for selling out and seeking shelter. But let’s examine why the hospital is forking over a boatload of cash to a surgeon it let walk away 3 years ago. It’s not the naming rights. The hospital has renamed the ASC St. John’s Hospital Surgery Suites. Nor is it the cataract profits it was surely and sorely missing since Dr. Yeh hung her shingle across town. Pride of ownership and a booming book of business are nice, but the real prize is that the hospital now gets to bill cataract cases at much higher HOPD rates.

For 2014, the Medicare rate for cataract removal with IOL insertion (CPT 66984) is $959.97 in an ASC and $1,740.50 in an HOPD, a difference of $780.53. Good intentions and glad reunions aside, Medicare’s cockeyed payment rates are what’s driving today’s ASC-to-HOPD conversions.

Of the 285 ASCs that left the Medicare system from 2009 through 2013, at least 101 were converted to HOPDs, according to the Ambulatory Surgery Center Association. If Dr. Yeh and her colleagues perform the same number of cases this year that they did last year (3,498), St. John’s will bill insurers an additional $2.73 million. Whoever thought that the ASC model would be used as a pawn to need- lessly drive up healthcare costs?


Keep in mind that the source of the money the hospitals use to buy out practices like Dr. Yeh’s, is the gross overcharging for “care” rendered in their facilities, resulting ultimately in the bankruptcy of the sick.  I thought this was a timely editorial to share, as the media focuses on Medicare payments to physicians, shedding no light on the much more outrageous and abusive hospital billing practices.  While a few doctors game the system for millions, the hospitals make off with billions, using this taxpayer dough to buy out practices like Dr. Yeh’s by the hundreds (thousands, actually).  

One more thing.  Doctors accused of Medicare fraud go to jail, innocent or not, as the cost of defense would leave their families homeless.  Hospitals and their execs accused of Medicare fraud?  Like big bankers, paltry fines.  Since the government will never abolish Medicare, there is really only one solution and it is fast approaching, as physicians walk away from this program en masse.

N.B.  I am embarrassed to have accepted Medicare money in my past but happy to say that I kicked this habit in 1992, 2 years after I began my practice. 

G. Keith Smith, M.D.

For more information on free market healthcare, visit:


HIPPA Audits, F-16’s and Tanks

Here is just a glimpse of what the government’s presence in medicine looks like.  Read the entire thing if you can, although I admit I had trouble getting through it.  

Two of the things I remember about Dr. Ron Paul’s office were the picture of Murray Rothbard looking over his left shoulder and the sign on his desk:  ”Don’t steal.  The government hates competition.”  Perhaps that is why the state wants to fine or imprison individuals who violate others’ privacy.  Perhaps the state wants to keep privacy violations jealously and exclusively to itself.

I have stated many times that “Medicare is the only ‘insurance company’ that has its own F-16’s and tanks and that is no coincidence.”  After all, the state is that institution with ideas so great that they have to be mandatory. The link above demonstrates:

1) the unveiled desire of the state to destroy the little guy

and (simultaneously)

2) the intentional creation of a demand for the services of those “consultants” needed to stay within compliance parameters, “consultants” who many times lobby for laws and regulations like HIPPA.

Many physicians and facilities are doing the unthinkable though, opting out of government payments altogether, a path the health apparatchiks did not foresee and a path devoid the teeth of the state.  The Association of American Physicians and Surgeons has macheted this path, providing step by step instructions on how to escape the trap of government payment.

Reports from physicians I know indicate that almost without exception, the Medicare “beneficiaries” understand their physician’s decision to walk away, not from the patient, but rather from the state payment.  The link above would perhaps make a good brochure for those “beneficiaries” who are angered by or don’t understand their physician’s move to “opt out.”

G. Keith Smith, M.D.

For more information on free market health care visit: