Friday, August 8, 2008

Two Medicare Anecdotes

I recently read the following e-mail about Medicare from a US medical student, which I am quoting with his permission:
My grandparents just this past week were told by their personal physician of 20 years (a close friend at that) that he was leaving his private practice to be a hospitalist for the same pay at half the hours, simply sacrificing his freedom in setting his own schedule. He did this because because the cost (both in time and effort) of practicing on his own was too great. When asked by my grandparents who he would recommend they seek out as their new doctor, he said he knew of no one taking on new Medicare patients in their town of over 100k.

I see this as leaving us as future physicians at a crossroads... go into private practice and spend a good deal of our time dealing with bureaucracy, but having a level of autonomy in treating our patient's as we see fit, or being an employee of hospital subject to the rules and regulations of administrators separated from actual patient care.

One possible solution to those of us interested in having the freedom and autonomy of private practice is exemplified by a [location deleted] general surgeon I had the pleasure of playing golf with a few months back. He had decided to stop treating Medicare patients which were 40% of his patient base, but accounted for 13% of his total income. By doing this, he was able to close his office one day a week (playing more golf he noted), saving the salary/wages/overhead that running a private practice office entails. In the end, he said he made slightly more money b/c he was able to eliminate the expenses required to treat these patients.
There are some politicians who wish to nationalize health care along the lines of "Medicare For All", on the grounds that Medicare has been such a huge success. Of course, this is a myth that has been rebutted numerous times.

But stories like this should give those politicians pause, since Medicare clearly penalizes doctors for treating patients. The recently described RAC bureaucratic nightmare is just one small example of this. If nationalized health care is imposed in this country, I anticipate many doctors will simply reduce their hours, retire early or quit medicine altogether to go into other fields.

Nor is this simply a matter of throwing more money at Medicare. If more money is thrown at it, costs will skyrocket out of control. Conversely, if costs are kept down by government controls, it will necessarily result in rationing. This is a consequence of a system in which the state attempts to guarantee health care. Such systems are doomed to fail, because they run contrary to normal free market mechanisms.

In contrast, the free market consistently delivers goods and services in a fashion where prices decline and quality goes up with time -- the exact opposite as we see with Medicare and other government-run health care. Note that we never hear of rationing with computers or cellphones.

The last thing this country needs is "Medicare For All"; instead we need the only moral and practical solution -- free market health care and health insurance for all.