All you have to to is talk to a retired doctor to find out everything that has gone wrong with our health care system as gvernment has become more and more pervasive in the system.

My father practiced medicine for 40 years in Lexington, Kentucky. As recently as the early 1960s, he made a good living (NOT extravagant – I wore plenty of hand me down clothes and went to public schools) while charging very affordable prices for his services. When Medicare was enacted in 1965 he warned everyone that it was the beginning of the end of our great health care system.

My dad used to care for many poor people. He and the hospital where he worked never turned anyone away. Most of these people had no kind of health insurance. If they could not pay their (single page, very understandable) hospital bill when they were discharged they could just set up a payment plan. My dad got as little as $5 a month from some patients. Sometimes he even took farm products as payment. We always had lots of fresh vegetables and fruit, and once even got a side of beef! And often he would simply forgive the charges entirely and just take it as a tax write-off.

In the 1970s, two things happened that changed everything. One, he got sued for malpractice, and two, the IRS told him he could no longer write off unpaid bills unless he hired a collection agency and made at least three attempts to collect the payments. His malpractice insurance premium went from $10,000 to $90,000 a year in ONE year. The hospital told him he could not practice there without it. And he had to hire a full time secretary and a collection agency to try to collect the payments he used to forgive for his poor patients. The cost of his practice literally quadrupled in two years. He had no choice but to raise his rates substantially as a result.

Meanwhile, people started living longer and longer and having more and more health problems in old age. Malpractice suits and IRS rules forced doctors to increase rates. Doctors and hospitals started ordering more tests, using more expensive disposable products and new technology to cut down on lawsuits. At first, Meedicare paid for all of this for elderly patients. As prices rose and collections became more aggressive, younger people who formerly were able to pay medical bills as they arose couldn’t, and started demanding more health insurance from their employers. As third parties started to take over payments for medical care, nobody had any incentive to keep costs down.

Soon enough, some doctors hit on the idea that with all this cash going though the system they could make more money by owning hospitals than by practicing medicine. Thus the profit motive was introduced into health care. Previously non-proftit hospitals were bought by the Humanas of the world, and they started paying doctors more so they all moved to the for-profit hospitals. The non-profits could not keep pace without increasing their prices. Somebody else was paying the bills, so nobody cared. This led to a further price spiral as the new companies sought larger profits.

Then in the 1980s, Medicare costs really started to skyrocket, while the federal deficit became critical. The government responded by cutting reimbursements to doctors and hospitals. So the providers had to start charging even more to non-Medicare patients to make up for the lost income. They have had to cut their patient examination times, limit hospital admissions and shorten the length of stays, and do all sorts of other cost cutting which has continually worsened the patient experience.

This has continued to the point that the government now pays only about 20% of the actual cost of most procedures for Medicare patients. The Medicare reimbursement schedule is larger than the entire U.S. tax code. Bills are incomprehensible. Doctors have gamed the system by committing massive fraud, charging for procedures not performed and visits not made. The average patient can’t figure it out and doesn’t care anyway since he isn’t paying the bill. My dad goes crazy every time he has to have a procedure because of all the bullshit on the bill that he knows wasn’t done. He has turned in 5 doctors for fraud. Doctors used to be the most honest and trustworthy people in the world. Our government has turned them into crooks.

The entire reason your health care is so expensive and such a lousy experience now is because Medicare and Medicaid costs have spiraled to the point that the government has had to cut the reimbursements and you make up the difference.

rockmom on April 27, 2008 at 11:21 AM