Obama's $25,500 Error

I’ve been seriously underpaid.  According to President Obama, I get $30,000 “right away” for amputating a diabetic Medicare patient’s leg. So I checked the two inch thick book of procedure codes, then called the biller and found that instead of  $30,000, I actually get $554 or $857 depending on the level of amputation. Obama probably thinks that difference of $300 will incentivize me to take off more of the leg.  

And does “right away” mean within two years?  Just ask the car dealers how easy it is to get the government to pay you even after you have spent hard cash rendering a service and have a “clean claim” as the Medicare bureaucrats call it.  Don’t feel bad, guys. After I bill the whopping $554, which covers the patient’s admission to the hospital, the surgery, and 90 days of follow on care, I will be paying out $15,000 in malpractice insurance before I get paid. And that’s only if it takes 90 days.  

It is not unusual to wait over a year for payment because of “questions” on a Medicare claim, or to get paid and then a year or two later have the government reach into my bank account and take the money back. After that period of time, of course, it is more difficult to remember the details which could help restore the money, and so sometimes we doctors give up — meaning we did the care for free.

Obama’s statement may have been a blatant attempt to prosecute class warfare and demonize doctors.  After all, doctors are generally trusted whereas politicians are not, and to ramrod this nightmarish health care reform bill the president doesn’t want patients and doctors standing shoulder to shoulder in opposition.  

His statement is frightening in its wilfull ignorance. His advisers come from the sixties school of Chinese barefoot doctor infatuation. Since my medical school days in the seventies, bureaucrats have disparaged highly trained medical specialists.  The liberals — mostly young, healthy liberals– are convinced that we nasty surgeons do surgery just to make our Porsche payment, and for illustration, they manage to trot out the rare jerk who does just that.   

In addition to profound ignorance about the practice of medicine (they do not choose consultants who are small business private solo practitioners), some of this is class envy.  Even among physicians, there is a constant whine by some of the general practitioners and pediatricians. ”Why do neurosurgeons get paid more than we do?”  Their complaint ignores the economic truth that in any real marketplace, the more training required, the more technical skill, the more difficult tasks one can perform, the more the remuneration.  

Paralegals make less than lawyers.  Admirals make more than seamen.  Ph.D.s make more than those with BS degrees, and Brett Favre makes more than the third string quarterback, because not everyone can throw a football, and not everyone can operate on your cranium.  

The Dems love general practitioners — and so do I, really, but family practitioners can’t fix broken bones, brain hemorrhages, or ruptured spleens. And we are dangerously short of those physicians who can do those things.  

The same people who do amputations are also those who care for you when you break your leg or are seriously injured in an accident. And most of these surgeons covering emergency rooms are over 50 years old.  Due to the shortage of nearly all surgical subspecialties, young graduates do not need to take jobs requiring trauma call, and they gravitate to those cushy areas with the least government funded population of patients: read “they avoid Medicare like the plague.” Southwest Arizona needs 10-12 orthopaedists to care for its rapidly growing population.  It  has two.  Northern and central Arizona have plenty of orthopaedists because they have privately insured patients and so can make more money per hour towards covering their overhead.  

Now you might conclude from this that the answer is to make all physicians see a certain amount of Medicare patients, so there is no incentive for specialists to congregate in cities.  And the government can mandate that everyone take trauma call. Of course, then we wouldn’t be able to pay those malpractice bills, nor the office overhead.  So government would end up taking over our practices.  

The Soviet Union created a truly awful medical system, not by excluding people but by forcing everyone — patients and physicians into the government mold (excepting, of course, the Politburo, who had their private plan.  Just like Congress does.)

The $30,000 Obama referred to is probably the total hospital bill.  And that bill is expensive for two reasons — malpractice and the federal government. The federal government via Medicare has, in the words of the Declaration of Independence, “erected a multitude of new offices, and sent hither swarms of officers to harass our people, and eat out their substance.”  
Some estimate that it takes three nurses to do the work of two thanks to Medicare regulation.  I think that is a gross underestimate.  Surgical items we once reused now must be thrown away, costing thousands of dollars per case more than necessary. (We often save our external fixators, for example, and send them to third world countries rather than waste such valuable items.)  

As for the malpractice cost, if the price were passed through to the customer openly, the problem would stop tomorrow. Unfortunately, the federal government (again) will not let you bill patients for your litigation overhead, so it is hidden in the price of an aspirin which goes from — and I am guessing at this to make a point — 10 cents real cost, to two dollars to cover the Medicare requirements of dispensing, and to five dollars to cover the malpractice insurance all along the line.  

The effect is compounded because the government and lawyers increase cost at every level of production and distribution:  the manufacturer who fights the feds for on average 15 years to get his drug to market, then fights the attorneys for the person who stuck the drug up his nose, then the pharmacy who has to cover the chance of someone slipping in its warehouse, to the nurse’s malpractice, and the hospitals enormous overhead.  Voila, $30,000.  Do you see any of this going away in a government run show?  

When government is the problem, more government  cannot be the solution.  Especially when run by the guys who believe surgeons cut off people’s legs to make $30,000.