I stopped accepting payment from the government for my services in 1993. This was one of the most liberating actions of my life, certainly of my career.  Recognizing that a payment from Medicare to me came out of the wallet of the young family next door to me for care rendered to someone across town they didn’t even know (and who in almost every case could more easily have afforded to pay me rather than the young neighbors) I quit taking the money.  After reading Bastiat and Rothbard and already inclined to achieve consistency, I simply could not waive the free market flag on one day and lobby on the capitol steps the next day for higher Medicare payments for physicians.  

I have come to the conclusion, however, that we are all property rights fundamentalists.  But for most, only for themselves.  No one wants a stranger to walk into their home and walk out with their car,television or cash or stamp collection.  Most of us, however, will vote for someone with the idea that the resulting political machine will do just that to our neighbors but for our benefit.  While I consider any government payments synonymous with stolen property, I do not judge physicians who accept these payments, as the leverage on their practices is significant.  To not accept government money for some physicians would be practice ending in many cases.  In spite of the difficulty and risks associated with walking away from Medicare, more and more physicians are doing just that, some because they crave consistency, some because the government has given them little choice by increasing the risk of dealing with Uncle Sam.  It is no coincidence, as I have said in the past, that Medicare is the only “insurance carrier” that has its own F-16’s and tanks.

Physicians are not just walking away from government payments.  They are also walking away from third parties like the big insurance carriers, dealing directly with their patients for payment.  I have written about these departures before, but wanted to restate them before I discussed the next and very exciting departure pattern I have been witnessing.

Physicians, who succumbed to hostile takeovers of their practices by large hospital systems, are walking away from these arrangements.  In large numbers.  These are not the “low producers,” as the hospital systems refer to them.  They are the primary care workhorses upon whom the hospital systems completely depend, those doctors whose practices represent the entry point for the bankrupting health cartel.  As these primary care physicians leave for private practice, the funnel to the mothership crumbles, leaving the hospitals to compete for physician loyalty and patients rather than rely on the old game where they receive referrals from their employed doctors whether the hospitals are any good or not.

Here is my message to those of you contemplating such a move from hospital employment to private practice and to those who are considering whether or not to become a hospital employee doctor.  60% of all medical bills not paid for by the government are paid by self-funded companies.  These are companies that have also walked away, having walked away from traditional insurance for their employee’s benefit, paying medical bills out of operational revenue.  This group loves my online pricing as you can imagine.  They have been waiting for the arrival of this development in primary care: the departure of the physicians from hospital employment, signaling the end of the cartel’s grip.  The self funded community (employers and those who administer their health plans) is huge and eager to support those who avoid hospital employment.  The demand these self funded employers represent so far outweighs the supply of non-hospital affiliated physicians at this point that the risk of walking away from a hospital is that your waiting room will not be big enough.