G. Keith Smith, M.D.

We are swimming in hypocrisy, it seems, a philosophical inconsistency the severity of which, in my opinion, should not be underestimated.  Individuals and organizations are increasingly taking the lead of the “state,” increasingly tolerant of simultaneous and philosophically opposing views, in essence, hypocrisy.  For example, actions that governments proscribe but actively engage in are too numerous to list.  

While the schizophrenic policies of governments and institutions do incredible damage to individuals and society, I think they also provide a clue into what the true and unspoken agendas are of the central planners.  Corporate healthcare, for instance, has been forced into an intense damage-control mode thanks to the larger than expected pushback by governors and their rejection of the “exchanges” and Medicaid expansion.  Allow me to explain.

The “business” community is dividing into two groups, those who are big fans of Obamacare (almost without exception those who financially profit from this legislation) and those for whom this legislation represents ruin.  Corporate health care cronies all over the country, rather than keep quiet about the billions they stand to make from this legislation, are writing opinion pieces for the media, local and national, advertising the supposed benefits of the Unaffordable Care Act, partly to justify and hide their theft of the taxpayers, and partly to pressure those who continue to reject this invasion by the “state.”  “Studies” have been commissioned from academics to show positive economic benefit and job creation from expanding Medicaid, for instance, having given no regard whatsoever to the simultaneous and equal or greater destruction of the economy and the loss of legitimate jobs resulting from this expansion of government.   More and more legitimate business owners see this propaganda as a poorly crafted deception and this is dividing corporate health cronies from their former pals in civic and business organizations, leaving them increasingly isolated.  The corporate hospitals have another problem, though.

Fearful of a separation within their ranks, the corporate hospital spokesmen are using support of this law as a rallying cry for the rural hospitals, the very hospitals these large corporate health groups have targeted for extinction with their hostile takeovers of rural physician practices and the resulting ruin of these small town facilities.  Typically, a corporate hospital will buy the practices of small town physicians who rather than continue to support the local hospital now under intense pressure from their new employer, refer their patients to their employer’s hospital, leaving the hometown hospital devastated-and open to an inevitable hostile takeover bid by the invaders.  And to think these corporate hospital goons accuse physicians who own their own facilities of unethical “self-referral!”

Most of the rural hospitals are fearful of the big city boys, but some are banding their rural hospitals together into groups to better withstand the invasion of the corporate raiders.  Incredibly, the corporate hospitals are desperately trying to hold things together, playing the role of defender of the smaller hospitals!  Even a temporary delay in the implementation of the Medicaid expansion and the exchanges will buy the rural hospitals some time, time the big boys thought they would never have, and time to re-evaluate their relationship to the state and national hospital organizations that have betrayed the rural facility’s interests. The corporate hospitals have serious issues on at least two fronts then, the potential secession of the rural hospital players from their fold and their abandonment by their former business pals. Their hypocrisy is catching up to them it seems.

I believe that the big hospitals underestimated the unpopularity of the Unaffordable Care Act, and certainly underestimated the extent to which the governors would reject this federal mandate, even if it meant rejecting federal money.  Now that their money train is threatened, the corporate hospital’s shrill attacks on Obamacare’s adversaries illustrate more clearly than ever their self-serving and greedy mission.  

Surprise, surprise.  The central planners miscalculate once again.  Who knows how this will turn out, but the public display of governor-bashing and ridiculous justifications of this law are more revealing than I think these corporate players would like to think.  I think the hypocrisy and self-dealing nature of the corporate health players has been very instructive indeed.

G. Keith Smith, M.D.

Governor Mary Fallin’s decision to reject the implementation of Exchangocare and Medicaid expansion has resulted in an earth-shaking development:  one of the members of the state board of health has noisily resigned, shooting his cap guns in the air on his way out.  What?  You didn’t notice?  

Dr. Glenn Davis, DDS, said,” It’s like federal funds are suddenly dirty.”  Continuing, “I will not serve as a ‘rubber stamp’ for the status quo in this political environment.”  There’s more. “Federal taxes paid by Oklahomans will now help pay for the health care of citizens in other states.” “It doesn’t make any sense to me.”  

Dr. Davis doesn’t get it.  He probably never will, in spite of my attempts to help him and others understand in this blog.

Stephen Gold, prominent Philadelphia attorney, is another matter altogether.  He understands completely.  The Oklahoman, our local newspaper, published his “point of view” on Dec. 5th, a piece containing his arguments for embracing Medicaid expansion here in Oklahoma.  

“If the state agrees to expand its programs, then by 2019 Oklahoma will get more than $13.4 billion in federal funds in return for spending $789 million in state dollars.  A ratio of 13,400 to 789 is a terrific rate of return on state funds and a great federal financial stimulus.”

Now let’s translate this insanity.

The Oklahoma government takes $789 million dollars from taxpayers in Oklahoma and gives it to the Oklahoma Health Care Authority, administrator of Medicaid.

In response, the federal government takes $13.4 billion dollars from Oklahoma taxpayers, then gives it to the Oklahoma Health Care Authority.  I can see why the leftist lawyer, Gold, thinks this is good deal for the Oklahoma Health Care Authority.  Looks to me like one theft after another of the taxpayers, though.  Unlike Dr. Davis, this leftist lawyer knows full well how this really looks on a balance sheet.  

What it is, is a transfer of wealth from taxpayers to tax takers.  You don’t have to read much in the news without encountering the corporate healthcare giants (hospitals primarily) drooling over the prospect of getting their hands on this dough.  Getting more money in the pockets of corporate healthcare was the entire purpose of Obamacare!  That’s why you and I are mandated to buy “insurance” for ourselves and Medicaid for those who can’t afford “insurance.” Undoubtedly, those in corporate healthcare see our bank accounts as a mere stopover of money due them.  

Giant hospitals need more money, don’t they?  Gold actually mentions the “poor hospitals” in his piece, lamenting the disappearance of the DSH (disproportionate share hospital payments, the uncompensated care rebate scam I’ve written about) payments first, then the loss of Medicaid money in general, second.  More money in their hands will allow them to more aggressively prey on the rural hospitals and physician practices,  and maintain or increase their support of sports franchises and their own ad and building campaigns.

Dr. Tom Coburn has cautioned in his writings about state addiction to federal funds, an addiction the roots of which lie in a refusal to acknowledge that the source of “federal funds” is your own or someone else’s wallet.  The “get all you can while you can” attitude and “if we don’t grab this dough, someone else will,” is what we have come to after all, isn’t it?    

Governor Fallin’s rejection of this federal crack cocaine is essentially an admission that must be made by all addicts:  we have a problem.  Hurray for her courage and that of all the other governors that have taken this stance, one which amounts to the refusal of yet another drink for our alcoholic government.

G. Keith Smith, M.D.

Much can be learned by the reaction to the refusal of several governors to implement exchanges or expand Medicaid in their respective states.  I have written at length about the usefullness of Rothbard’s “cui bono” (“who benefits”) concept, to pull back the curtain in an attempt to find the real reasons for this or that government policy/action.  In other words, no matter what some government apparatchik proposes, look hard for the beneficiaries of that action and you’ll more than likely discover who was behind it.  

On the flip side and as a corollary concept, those who whine the longest and loudest when a government policy is not pursued, are those most likely to have benefitted, had the policy been realized.  The reaction of the corporate hospitals to Governor Mary Fallin’s decision to reject creation of an exchange and her refusal to expand Medicaid illustrates the validity of this and signifies a division in the “business” community that merits consideration.  I think Governor Fallin had to know this rift would result, making her decision all the more remarkable.  

Hospitals and insurance companies have as much or more support on the Republican side of the aisle as they do on the Democrat side, historically.  Many times, hospital CEO’s are treated as fellow “businessmen” by those in the business community.  The wild profits of hospitals are tolerated as regrettable but necessary.  Hospitals smooth this situation over by constantly treating anyone within earshot about how much care they “donate” or give away and their “contributions” to the community.  While the hospital-men (modern day highway-men) quietly prayed for Obamacare’s healthy future, other businessmen saw this legislation for what it was:  the most gigantic over-reach of federal power in recent memory and one that threatened the very existence of their businesses and enterprises.

Certain Republican legislators having long been in the pocket of the big hospital lobbyists and big insurance, have been in a jam.  They had to look like they were against Obamacare to the folks who voted for them, all the while knowing their corporate benefactors were counting on them to do their part.  As the governors contemplated nullifying this law, we heard…”..it’s the law of the land, now that the election is over,” and other such statements in an attempt to disarm the rebellion.  

In chapter 43 of Thomas DiLorenzo’s blockbuster new book, “Organized Crime:  The Unvarnished Truth about Government,” he writes the following:

“As common as it is to speak of ‘robber barons,’ most who use that term are confused about the role of capitalism in the American economy and fail to make an important distinction-the distinction between what might be called a market entrepreneur and a political entrepreneur.  A pure market entrepreneur, or capitalist, succeeds financially by selling a newer, better, and/or less expensive product on the free market without any government subsidies, direct or indirect.  The key to his success as a capitalist is his ability to please the consumer, for in a capitalist society the consumer ultimately calls the economic shots.  By contrast, a political entrepreneur succeeds primarily by influencing government to subsidize his business or industry, or to enact legislation or regulation that harms his competitors.”

If you apply DiLorenzo’s distinction to the business community, two types of entrepreneurs certainly appear, the vast majority of those in the healthcare business falling into the “robber baron” group.  Imagine a chamber of commerce meeting where those political entrepreneurs in the various health businesses had to wear an “O” signifying their support of Obamacare, legislation that may represent the ruin of many others in the room.  Unable to satisfy the political and market entrepreneurs with her decision, Governor Mary Fallin sided with the free market bunch by rejecting the exchanges and refusing to expand Medicaid (which basically amounts to loading more passengers on the Titanic in the words of one legislator).  

Good for her.  She should wear as a badge of honor the various attacks she is receiving from the political entrepreneurs in the healthcare business sector.  Contrast the principle of her decision with that of New York’s mayor, who pulled his sword in defense of union workers, rather than accept the much needed non-union help in Sandy’s aftermath.  

G. Keith Smith, M.D.

I have referred to states creating their own “insurance exchanges” consistent with Obamacare, as “constructing your own gallows.”  States that are expanding Medicaid are doing further damage by helping to build a constituency.  As George Bernard Shaw famously said, “the government that robs Peter to pay Paul will always have the support of Paul.” Beneficiaries of government loot aren’t likely to vote against someone whose campaign is based on taking those goodies away. 

Creation of vast new numbers of Medicaid recipients virtually guarantees that they will only politically support those who maintain or even increase these benefits.  I agree with Mencken who described elections as “an advance auction on another’s property.”  It thus pains me to provide this political admonition to those supposed “conservatives” out there who are actually considering expanding Medicaid in their states. 

Medicare beneficiaries shred anyone suggesting that this Ponzi scheme be curtailed or eliminated, paying little attention to the rational arguments, reacting many times like an entitled voter bloc.  Same with Social Security.  I’ve heard all the arguments.  “I paid into that.  That’s my money!”  There is no point in pointing out to people who say this that they have probably long since consumed any money they paid in.  It makes no difference to many of them that thieves in Washington made off with the money they did pay in long ago, the source of funds for the current beneficiaries being the future elderly, who will likewise victimize their young. 

One of the cynical truths about American politics is that just as politicians can be bought and sold, so can the voters.  What beneficiary of a government program is going to support the politician advocating for ending this handout?  Every handout from Uncle Sam comes from someone’s wallet.  Increasing the number of folks at the trough adds to the power of those willing to “redistibute” the wealth of taxpayers.  

Justice Roberts interestingly gave the states an “out.”  Why on earth wouldn’t the states seize this opportunity?  Embracing Medicaid expansion will bring financial hardship to those states that take this road and for what it’s worth, wreck political devastation on any state “leaders” that decide to undo this later.   

The big hospitals want this Medicaid expansion.  Many of the big insurers want this Medicaid expansion as this will remove the liability of many of the sickest and poorist of patients from their roles.  “Conservatives” who expand Medicaid in their states will be acting in the interests of the health cartel, giving little thought to future consequences.  American politics.  Everything’s for sale.  Grant favors now, make others pay later.  Current “conservatives” pulling the trigger on future “conservatives.” Yet another Ponzi scheme.

G. Keith Smith, M.D.

The Oklahoma Health Care Authority (OHCA) is an agency that was created here by the corrupt Governor David Walters in obeisance to the just-elected Bill Clinton’s regime.  In anticipation of Hilliarycare’s passage, the OHCA was to act as a state “exchange.”  Sound familiar?  Rather than disappear with the failure of Hilliarycare’s passage, it has, like virtually all state and federal programs grown exponentially, now with an operational budget of almost 40 million dollars.   This agency took over the administration of Medicaid from the state Department of Human Services and now administers this 5 billion dollar mess.

I thought at the time that Walters pushed this agency’s creation through the state legislature to secure some kind of healthcare spot in Washington for himself as a reward for being the first to take this step.  Interestingly, our current governor is waiting until the presidential election results are in before declaring whether or not she will support setting up an Obamacare “exchange” here in Oklahoma.  Walters and his old pals, including recently-returned state Medicaid director, Dr. Garth Splinter (no libertarian), probably find all of this very amusing.

The OHCA is recently in the news, having approved the hiring of a RAC auditor.  RAC (not unlike a kick to the groin) stands for Recovery Audit Contractor.  These “contractors,” whose hiring is required by Uncle Sam, audit Medicaid claims and identify overpayments to “providers,” receiving a commission for the amounts they declare as overpaid.  If you are thinking that they are inclined to overstate “overpayments to providers” you get a gold star.  

Physicians and facilities that are exposed to this type of shakedown will be effectively denied any appeal if they feel falsely accused, as the expense of battling these accusations will be daunting and the legal and financial resources of the government contractors will be unlimited.  

What do you think physicians will do now that the pathetic Medicaid reimbursement, far below the market-clearing price for physician services already, is matched with the threats of RAC audits?  If you think physicians will be even more inclined to rid their practices of Medicaid patients, you get another gold star.  

Isn’t this classic central planning?  Only government could come up with an anti-fraud program that would serve to eliminate access to health care.  The politicians look good “cracking down” on fraud, the director of the OHCA publicly opposes the RAC audits and the scarlet letter of “Medicaid” becomes all too real for its victims.  Physicians will be vilified for denying care, acting as scapegoats for these bureaucrats.  This is going on with Medicare, as well, payments withheld from physicians and facilities for routinely over a year and once again, the denied amount forming the basis for the “contractor’s” commission.  

No one is talking about the most obvious Medicaid fraud of them all, the payment relationship between the OHCA and the “not for profit” hospitals.  Medicaid payment to these hospitals far exceeds the prices we have listed on our website.  If you then add in the “uncompensated care” padding and the “provider tax” kickback the OHCA pays these big hospitals, the payment in excess of our displayed prices is stark.  

Seems to me like the real fraud is that while the OHCA and Garth Splinter’s Medicaid bankrupt the taxpayers with these fat payments to their hospital pals, cheaper and I believe better care is provided just down the street at our facility.  Preserving favors for their pals, erecting barriers to care for the poor.  A classic lesson in government corruption and incompetence.   The RAC bunch doesn’t make any money from this, though.

G. Keith Smith, M.D.

Let’s say that a “not show a profit” hospital happens to be paid 3 times by Medicaid what our surgery center is paid by a private insurer.  Yes, you read that right and it’s actually true.  Keep this in mind as you hear politicians talk of their concern about government spending and the bankruptcy of health plans like Medicaid! Let’s break this down.  

Let’s say that the surgical procedure we are considering results in a payment to our surgery center of $1000 from private insurance (an actual example).  Actually, the $1000 is what the insurance company calls the “allowable” charge.  If  a patient has a $2500 deductible, it should be clear that they are paying for this particular procedure completely out of their pocket if they’ve not met their deductible.  If they have met their deductible they are probably still going to have to pay some percentage of the $1000, probably 20-40% out of their pocket, still a significant portion of the charge, given that they have paid $800-900/month, minimum, for this “coverage.”  

Now let’s look at this from the hospital angle.  Same procedure.  Medicaid pays the hospital $1500.  Then the disproportionate share hospital padding is added, in this case, another $1000.  Then, the “provider tax” (see my blog about how this works here) amount kicks in, bringing the payment to a little over $3000.  But wait a minute.  The hospital doesn’t pay tax!  This “minor” concession basically doubles the value of the compensation!  

But wait.  Isn’t the hospital cost-shifting to everyone with private insurance due to the “losses” they sustain on these Medicaid payments?  It’s not hard to show losses if you subtract their Medicaid compensation from their outrageous hospital bills, though, is it? And the uncompensated care padding is predicated on the “not for profit” hospitals generating these fictitious “losses.”   Wasn’t one of the main reasons we were saddled with the Unaffordable Care Act was to guarantee payment to these “struggling” hospitals, so they wouldn’t shift costs to the rest of us to cover these Medicaid “losses?” 

Now keep in mind I am comparing private insurance payment at our facility to Medicaid payment at a “not for profit” hospital.  I have done this intentionally so that you can see that the worst paying insurance (Medicaid) pays the hospitals multiples of what private insurers pay our facility for the same procedure.  

Big hospitals going broke?  Give me a break.  Little hospitals are going broke thanks to the big hospitals, that’s for sure.  Hospital bills high because costs are shifted from Medicaid and other losses to those who are paying?  Give me a break.  Obamacare will lower our health costs due to its remedy of this situation?  Seriously?

G. Keith Smith, M.D.

Want to know what will happen to the price of your insurance premiums once the individual mandate kicks in?  Look here at what happened in Massachusetts when Romneycare was implemented.  I would encourage you to continue to ask “cui bono” as you read this article.  If you have followed this blog for any time at all you’ll probably come up with the same answers I did.  Not satisfied with bankrupting individuals, the Medicaid expansion provision touted by those in the article will bankrupt or squeeze the state governments, forcing them to face new revenue raising strategies.  How long will governors stay tough on this?  Probably not long.  How do you like Greenwald of Harvard’s comment that Medicaid expansion is a really good deal for the folks in Texas?  After all, the federal government (where do they get their money????) will pay for almost all of this expansion!!

Why can’t we just let the market work?  It’s not because the poor will be left to fend for themselves, all of the cries to this effect notwithstanding.  Market pressures have reduced prices such that cars, computers and cell phones are within financial reach of almost everyone.  Why would anyone think that health care is any different?  It’s not.  The problem with letting the market work is that the folks that are paying off lawmakers at all levels of government wouldn’t have a trough full of your dough and mine at which to gorge themselves.  Rather than succeed through an appeal to the legitimate needs of customers, big business has found it easier to appeal to the greed of the slimy legislators.  One of the advantages of this business approach is that crushing upstart competitors is part of the deal.  

Think the Romneycrats will shun this corporate gravy train?  Think if they “get the power” they will alienate their old pals in the insurance and pharmaceutical and hospital industry?  

After reading the article linked to above you will see, I think, that the whole point of this Unaffordable Care Act is to make care unaffordable for enough folks that we’ll get to see the sequel.  I’m going to give it a name now.  Unicare.  Give me some ideas if you think there’s a better one.

G. Keith Smith, M.D.

Someone asked me in disbelief earlier today how we could charge so little for surgical care at our facility.  You can see our prices here.  ”It’s one thing,” I said, “that our prices are so low.  It is another thing, altogether, that you can view them online.”

Posting our prices is what my friend Jay Kempton of the Kempton Group calls, “doing the unthinkable.”  Jay is the principle of The Kempton Group, a firm that provides benefit advice to and processes claims for companies that choose to self-fund, for purposes of health benefits for their employees.  Imagine how his clients feel about paying a fraction of what they were paying for the same surgeries (and I would argue better quality) at “not for profit hospitals” and that they know in advance how much it is going to cost.  

Continuing with questions from this morning: “How did you come up with these numbers,” I was also asked?  ”What percentage of Medicare?”  I explained that physicians basically bill for their time and that we know how long surgery will take most of the time and that as the managing partner, I know what the supply costs are and basically how much it costs to run an operating room for an hour.  I also explained that “Medicare reimbursement” doesn’t really mean anything to me.  Anyone setting fees will be wrong, one way or the other, as the market clearing price will vary from place to place, day to day and vary according to the facility or surgeon.  A very busy, high quality surgeon will be unlikely to make himself available for Medicare rates, for instance.  

I informed this individual that I stopped accepting Medicare and Medicaid funds in 1994.  “This doesn’t make sense.”  ”Since you are running a physician-owned facility and are self-referring, your prices must be higher than the ‘not for profit’ hospitals, since they are not as greedy for profits.”  

I explained that it is precisely because we are a physician-owned facility that our prices can be reasonable, as, unlike our mis-named “not for profit” hospital competitors,  we don’t care if the facility makes a bundle, we just don’t want the facility to lose money.  As long as our professional, physician fees are reasonable, we don’t need for the facility to charge much above what it actually costs, to be content. Physicians’ (taking in less than 10% of the health care dollars) fees are cheap compared to the typical institutional fees.

“So you’re telling me that I am more likely to find a reasonable price at a physician-owned facility that at a “not for profit hospital?”  Followers of this blog know by now that this person had never seen my blog.  

In a completely different tone now:  ”Is it fair to say then that physician-owned facilities will lead the way in price transparency and reasonably priced delivery of health care?”  

“Yes,” I said.  I restrained myself from telling them to go to the head of the class with this remark.  

Continuing, I said, “that is why the Unaffordable Care Act specifically stopped the development of any new physician-owned hospitals, some even already under construction, like the Texas Spine and Joint Hospital.  This proscription gave the cartel cover, protecting them from high quality and affordable competitors, consistent with the intentions of the bill’s authors, increasing the cost of care dramatically.”

I have come to believe that the reasonable amounts we charge at our facility are not the most radical departure from the rest of the medical industry, but rather our display of those charges.  That our display of prices is seen as so radical is, however, an indication of how sick the medical economic system is in this country, as every other industry must contend with price calculation challenges.  

The answer to our problems from Washington?  More government, price controls, less competition for the big hospitals, more regulation, insurance industry consolidation bordering on monopoly, budget caps, tax code tweeks, mandated computerized medical records and mandated first dollar insurance purchases.  And it’s called the Affordable Care Act?

G. Keith Smith, M.D.

A democrat legislator recently chided those governors not embracing Obamacare’s Medicaid expansion.  The gist of her argument was that most of the expense would be borne by the federal government anyway.  Where does this cretin think federal funds come from? 

Just as troubling to me is the general acceptance of state agencies helping private businesses garner federal funds.  We have seen this with the provider tax here in Oklahoma where private hospitals pay a 1% tax to have it returned to them 3 fold.  These outfits are hoping you won’t connect the dots between the “tax” they pay on one hand and the loot they grab from your pocket with their other hand.  

This crony corporate welfare enabled by state legislation and agencies is what I like to call “favors we can live without.”  Rex Smitherman in today’s “Daily Oklahoman” tells us the story of Cyrus Zegrati, a microbiologist who Mr. Smitherman mentors on the fine art of pick-pocketing the taxpayers.  Mr. Smitherman’s organization, i2E, is funded in part by the Oklahoma Center for the Advancement of Science and Technology (OCAST), one of whose goals is “to boost the state’s share of SBIR (Small Business Innovation Research) grants.”  

Let’s summarize.  Mr. Smitherman, CEO of a “nonprofit corporation that mentors many of the state’s technology-based startup companies,” is the recipient of your wages and mine through a state agency (OCAST), and his job is to help people like Mr. Zegrati find his way in to your wallet through NIH (National Institutes of Health) and SBIR grants. 

How is this any different from the crony capitalism so vilified on the federal level, the bailouts of the banksters, Solyndra and many others?  Isn’t this moral hazard, that situation where one is set up to profit from placing other’s money at risk?  

Entrepreneurs risk private capital for gain.  Successful ones are those able to predict future demand for services or products that help their fellow man in some way.  Those seeking and obtaining public, taxpayer money for their private gain are another type of individual altogether, rightly referred to as thieves, as they are truly the recipients of stolen property.  That they have harnessed some “acceptable” means of extracting what is in our wallets really makes no difference.  That they have an intermediary do their dirty “wet” work, still results in our being robbed of resources we might have more pressing uses for in our own households. 

Mr. Zegrati’s idea may have been appealing enough in the private sector to gain the confidence of private investors, but sadly, we will never know.  If his “company” is successful, he will actually be an example of someone “who didn’t build his company.”  Forcibly redirecting private money for public use results in mal-investment and allows bad and unprofitable schemes to proliferate, as the ruin of failure is shouldered by the taxpayers not the visionary, throwing much of accountability to the wind. 

I wish Mr. Zegrati the best.  I just wish he had pursued his dreams without money taken from the rest of us without our consent.  That our state legislature taxes us to enable this heist at the state and federal level is truly unconscionable.  

G. Keith Smith, M.D.

In an article by Noam Levey of the Tribune, Washington Bureau, Dr. Scott Gottlieb, a Romney advisor says,”..Medicaid is worse than no coverage at all.”  Sounds like Dr. Gottlieb is a follower of Dr. Jane Orient, whose succinct evaluation of the Unaffordable Care Act goes like this:  ”coverage does not mean care.”  

Would he agree that 32 million newly insured folks might be worse off than prior to receiving Obama’s gift?  If a Medicaid card doesn’t grant access to care, why would anyone think that an Obamacare card would?  And why is it that Medicaid patients have trouble getting care?

My apologies to followers of this blog, as you already know the answers.  I point this out as a rare glimpse into the real world of the policy wonks.  This physician, Dr. Gottlieb has hit the nail on the head.  My guess is that this is a bit too blunt for Mr. Romney.  Not so for Rep. Jim Jordan, OH.  Later in the same article, Jordan puts his own party (GOP) on notice, saying, “..if we win there are no more excuses.”  He would cut 2 trillion from Medicaid in ten years and block grant (punt) this entitlement to the states for them to unwind.  

Governor Bob McDonnell of Virginia, said basically, these cuts were not a problem.  Ok.  So far so good.  Now who do you think is opposed to these cuts?  If you guessed the “not show a profit hospitals,” you go to the head of the class!

Dr. Bruce Siegel, president of the National Association of Public Hospitals and Health Systems, threw down the quality card.  He said people with Medicaid are healthier.  But Dr. Gottlieb says people with Medicaid have less access than those without.  Siegel said that Medicaid makes folks more financially secure.  I think he means that they are less likely to be medically bankrupted by the hospitals in his association.  I suppose if they didn’t charge patients 10 times what we do at our facility for the same medical care, patients might not need to fear bankruptcy from medical care as intensely.  

Expect to hear more and more of this stuff.  As the topic of the lack of access continues to raise its head and the talk of what medical care really should cost raises its head, you will hear the “not show a profit” hospitals scream.  If the hospitals have to justify their pricing and why they are unnecessarily bankrupting the poor and sick by overcharging them, they will switch gears and go on to their next tactic:  they will “poor mouth” it.  They will attempt to convince everyone that without giant Medicaid spending, they will go bankrupt! The truth is that they won’t be rich and happy until the entire country goes bankrupt on their behalf!  

G. Keith Smith, M.D.