At the end of 2012, like the end of many prior years, physicians faced the draconian Medicare cuts, the threat of which has served to be one of the most effective fund raisers for politicians in history.  SGR.  Sustainable Growth Rate.  Calculation of what this cut might have been involves a complex series of factors, affecting some doctors more than others.  Some specialists were anticipating cuts of as much as 23% in pay.  Alas, the “Doctor Fix,” although temporary, arrived just in the nick of time, as sufficient contributions to the D.C. extortionists rolled in.

“Either we cut the doctor pay by up to 23% or the country might go broke!”  “Cuts are inevitable.”  “We will have to face this one of these days.” “There is simply no other way.”  

Those of you who follow this blog know my thoughts on Medicare, indeed on any government involvement in health care at all.  However…..

Keep in mind several things.  Medicare pays the “not for profit” hospitals twice what is listed on our website for the same operations.  Hmmm.  How did this happen?  Medicare pays the local teaching hospital twice what it pays the physician-owned hospital for a joint replacement.   Hmmm.  Now my favorite.  Medicare pays hospitals for the services provided by their physician employees 40% more than for the same services provided by non-hospital employee doctors.  Hmmm.  

I see not only a potential for savings, but a pattern.  This is without a doubt an assault on the private practice of medicine by the government, an attempt to drive physicians to be hospital employees, at once lining the pockets of the health cartel lobby and annihilating the remnant of doctors who take the patient-doctor relationship seriously, those doctors who are pushing back on further medical intrusion by Uncle Sam.  The buy-electronic-health-record-systems-or-else policy by Medicare is yet another move that has cut the net pay to physicians in private practice and a move that has brought many doctors to “throw in the towel.”  

What the feds and the cartel didn’t anticipate was the form which this “throw in the towel” would take.  Large numbers of doctors aren’t quitting their private practice to become hospital employees.  They are quitting altogether.  An alarming number aren’t quitting, just opting out of Medicare, Medicaid and many are opting out of third party relationships completely.

Next time you hear that Medicare and Medicaid are going broke, remember the real purpose of these entitlement programs is to make sure that your tax money makes its way to those who have bribed their way to the trough, the players in corporate health care.    

G. Keith Smith, M.D.