"You mean I can't pay my doc extra?"

The physician-blogger Happy Hospitalist describes the perverse economic incentives imposed by the government that are destroying primary care medicine. Here are some excerpts from his post about his wife's sister's medical options:

...But back to the original discussion. Should she go on the ranks of Medicaid while in school? I warned her that in this area, most docs will never see you. You will be bound to the ER for primary care services. I explained the economics of the situation. She offered to pay her doc more.

Ah, there in lies the problem. I explained quite clearly that Medicare/Medicaid does not allow "balanced billing". Even if the patient chooses to pay more, it is illegal for her to charge more. It is also illegal to charge a cash paying customer a fee less than Medicare pays, if that docs accepts Medicare. In other words, Medicare would want that smaller fee. So, they won't pay more and you can't charge less. How absurd.

She was surprised that it is illegal to pay the difference between what we charge and what insurance collects. Here is a potential Medicaid patient willing to pay her fair share, and the system won't allow it. Why? I have no idea why. Both patient and doctor win. Patient gets access, Doctor gets their fair fee.

She talked about using chiropractor services, about how they offered to "work with her" as an uninsured client. This is capitalism. This is how it should be. Right now, we can't "work with her". It's either in or out. If she's in the Medicaid system, nobody will see her. If she's out, we can't charge her less than the Medicare fee schedule or it's considered fraud. Even though the cash only model allows for lower costs because billing/collections/ resource utilization is lower.

This socialistic model is killing primary care.

By forbidding patients and doctors from contracting for medical services at a price agreeable to all parties, the government is violating individual rights and harming everyone. (Via KevinMD.)