Continued from Lee County

The two articles on this page, both printed in “Guest Opinions” in the Fort Myers News-Press, August 24, 2012, share an opinion on the Republican Medicare Reform plan (Paul Ryan) and Obamacare. Essentially, these medical ‘experts’ don’t like the other’s plans.

Here’s my take.

Any major change in the way Medicare is serviced by doctors and medical facilities in the USA, will be, by definition, a catastrophic failure. For analogy, let’s hypothesize: Suppose America decides it no longer will send its military to different parts of the world to defend anyone but Americans; not to Iraq, Afghanistan, Kuwait, Europe or the Pacific in WWII, Korea, Vietnam, etc. 

Many Americans would say “fine.” Especially in Vietnam and Korea. After all, a lot of Americans would not choose to die for the freedom of the Koreans, French, Dutch or English People. In fact many would not be willing to put on a uniform to defend America period; Michael Moore, Bill Clinton, and Jane Fonda come to mind. But aside - while most Americans would see gray areas concerning American soldiers dieing in Vietnam or Korea, few would question America’s participation in WWII.

The current Medicare program in the U.S. is performed in secrecy. As Medicare benefits were reduced over the years, even before budgeting problems began, and payments to doctors were reduced, doctors and hospitals faced a deep cut in their incomes, while finding a boost in their workloads with the enlargement in the senior citizen population. Increasingly, hospitals, with the Clinton-era mandate of taking in all emergency patients regardless of their ability to pay, found that absent an increase in revenues, their alternative choice was to close their doors. ( ), which many, perforce, did.

Facilities that opted to stay open and provide medical services to their patients and especially to those on Medicare and Medicaid devised a clever accounting system to maintain their facilities, keep earning a good living, and to provide medical services to everyone, regardless of a patients ability to pay.

Here’s how it works - I‘ll use only the doctor as an example - let‘s call him, oohhh? Dr Krevorkian: 

1. Federal or State bureaucrats set a limit that Medicare or Medicaid is willing to reimburse a health provider for performing a certain medical procedure. Let’s say, for a heart bypass operation: $45,000.

2. Dr. Krevorkian’s costs, including hospital charges for the OR, OR Nurses, attending physicians, pro-rated office rent, malpractice insurance, etc. comes to, say, $50,000. 

3. To obtain what the physician thinks he is due after 10 years of school; huge education debts, his kids braces, and his cocaine habit, the doctor feels 20% markup is reasonable: $10,000. 

4. Total cost plus ‘profit to Dr. Krevorkian : $60,000. Medicare/Medicaid will only pay $45,000 remember?

5. So Dr. Krevorkian has two choices: 1. Refuse to do the operation (which is a felony for Medicaid), or 2. Don’t accept Medicare and/or Medicaid patients into his medical practice - and many doctors do not.

6. Or door number three (drum roll please): Charge Medicare/Medicaid $90,000.

A. Write the difference off as a business loss (All doctors are incorporated):

      (a). $90k minus $45k = $45k write off.
      (b). Dr. Krevorkian is in the 30% tax bracket.
      (d). Dr. Krevorkian saves 15k in taxes - (30% x $45k).
      (e). Dr. Krevorkian makes his $60,000 - ($45,000 from the government + $15,000 in tax savings.
      (f). Dr. Krevorkian makes it up with speaking engagements, or drug company kickbacks.
      (g). Who loses? IRS.
      (h). Who cares? Priceless.

B. Works the same way for the private insurance companies too. 

So does it matter if Medicare or Medicaid won’t pay the whole shot? The system rolls on and it works. Implement radical changes like the Paul Ryan ‘plan’ or Obamacare and see how many Medical Students become plumbers, or how many doctors refuse Medicare and Medicaid patients, or how healthcare insurance premiums soar, or how quickly we all get socialized medicine.

Then wait. If you think healthcare is expensive now, wait until it’s free !!

If it ain’t broke . . . . Don’t try to fix it.