I stopped taking federal money in 1994.  I realized that government was huge and out of control and thought that anyone taking federal money was on the dole.  It finally dawned on me that I too was on the dole as a physician accepting Medicare money.  This money, after all, ultimately comes from a taxpayer stick-up by Uncle Sam.   But to be frank, the federal government made it easy for me.  When I started practice in 1990, Medicare paid me about $1100 for the anesthetic management of an open heart procedure (about 3 to 4 hours of my time depending on the surgeon).  When the Harvard cretins came up with the RBRVS (resource based relative value scale) the government took the opportunity to “stick it” to the hospital-based physicians (anesthesiologists, radiologists, pathologists and emergency room physicians).  Our reimbursement was cut in half.  One year later….ready?….they cut that in half.  The last open heart anesthetic I did was an extremely difficult case that took about 6 hours due to many unsuccessful attempts to wean the very sick patient from the bypass machine…he eventually did well.  Medicare paid me $287.  The last anesthetic I gave for a Medicare patient receiving a knee replacement paid me $78.  This kind of reimbursement for my work made it easy to leave this work behind.  I must at this point pay homage to the people that helped me see the light and eliminate Medicare from my practice:  Dr.’s Lois Copeland, Michael Schlitt and Jane Orient.

To the point:  the federal government is an unreliable and bankrupt customer.  What I mean is that doing business with Uncle Sam is a risky proposition at best and is becoming even more so.  Not long ago the latest “F” series fighter jet contract was  jeopardized by the failure to increase the debt ceiling and come to a budget deal in Washington.  Maybe it’s time for military and other vendors to realize what physicians have known all along.  As a customer, Uncle Sam is an unreliable bill-payer.  If the physician experience with Medicare is any indication, this will only get worse.  Cuts in pay are a constant threat and Lord help any physician that makes an innocent mistake on a Medicare claim.  Jail time and bankrupting legal proceedings have become common-place.

Lockheed is planning on selling 30-odd “F” series fighters to Iraq (wait?…aren’t we still at “war” with them?).  Maybe Lockheed has figured out they need to sell their planes to folks that are reliable and have the money.  As a physician I welcome Lockheed and any others that recognize the increasingly futility of dealing with Uncle Sam as a customer.

G. Keith Smith, M.D.