Surgery Center of Oklahoma Blog

September 19, 2011

Bastiat, Obamacare and Brain Infections

Filed under: Uncategorized — surgerycenterok @ 3:00 pm

Is health care in the United States a mess?  Of course it is.  I don’t think anyone argues this.  The argument starts when trying to answer the question, “why?”  Has health care in the U.S. always been a mess?  I think most folks would answer, “no.”  O.K.  I know this sounds like a marriage counseling session but stay with me.  I would argue that the answer is right in front of us.  Frederic Bastiat, the French philosopher and statesman used a method of argument known as “reductio ad absurdum.”  He would reduce (or magnify) an argument in scope to make his point clear.  If, for instance, a tornado and its inherent destruction was good for the economy, then why not completely destroy an entire city…or state…or country?…think of how great that would be for the economy!  This was how he approached many issues that were not entirely clear or that he thought were perhaps true on the surface but rotten at the core (specious).  As more and more political pressure was brought to make trains stop in certain towns in the French countryside, the stops that the trains were mandated to make by the government were so numerous (and economically unjustified) the operation of the train was not possible without heavy losses.  Bastiat recommended in his usual style that the train be operated in reverse!    O.K….to the point.  I maintain that health care in the U.S. is a mess due to the extent to which government at all levels is involved.  This involvement introduces price distortion and malinvestment not only in patient care but also in research and in the availability of pharmaceuticals and innovative new approaches to disease management and….you get the idea.

Now before the argument starts about my last statement, let’s look at this through Bastiat’s lens.  Let’s take government involvement in health care to the extreme.  Let’s actually find an example where  it is ILLEGAL  to buy health care  for yourself!!  Go to the head of the class if you said, “Canada and North Korea.”

How does this system work?  I  just spent 3 days with Rick Baker, the Canadian surgical broker.  He is a bit of a legend in Canada.  His success stories are a source of the most damning embarrassment for the Canadian government and their health care scheme.  We could argue this or that point, but’s what’s the point?  Canadians are coming to Oklahoma City for surgical care. Ouch.  What was that you said?  You were thinking of trying to prove to me how wonderful their system is?  But I just popped your balloon didn’t I?  Are they coming to Oklahoma City because the care here is cheaper?  No.  The care in Canada is free.  They have to pay here.  But wait!  If it’s free there, why are they coming here?  Ouch.  Because it isn’t there.  This is like a store that lures people in with a sale on items they don’t have on their shelves then takes credit for helping the poor with low prices.

I hesitate to repeat any of the horror stories related to this government manufactured rationing of care for fear of leaving out a possibly even more outrageous example that has slipped my mind.  There are so many sad stories that it is difficult to keep them all straight.  How about an 8 year old little girl going deaf from a middle ear infection put on a 15 month waiting list for placement of ear tubes?  She eventually lost all of her hearing in one ear, half in the left and had to have a neurosurgeon drain a brain abscess from this neglect.  Or a man that Canadian cardiologists all agreed needed urgent coronary artery bypass surgery put on a 6 month waiting list?  He was operated on 24 hours later in Oklahoma City with a life-saving bypass operation.

As Rick has said to the U.S. Congress in his testimony, and as he has said to me many times,” this really the system you want in your country?”  The Surgery Center of Oklahoma has provided care to many patients sent to us by Rick.  Here is another interview with him.  Watch this interview with a woman I helped get to Oklahoma City.  I am proud  to claim to be the one that helped Rick Baker and Canada find Oklahoma.

Washington has given us Canadian health care.  Where will we go when we need care?

G. Keith Smith, M.D.

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September 15, 2011

Enlarging the Integris Sign in Edmond

Filed under: Uncategorized — surgerycenterok @ 9:24 pm

The City of Edmond has approved a request by Integris to enlarge the sign on their new hospital, so the facility could be more visible to passersby on nearby I-35.  Seems like this desire to increase their visibility might be an attempt to attract more patients.  I’m not sure how this jives with their desire to “not make a profit.”  If you have been following this blog you know by now that “not for profit” really means “don’t pay tax.”  I’ve said for years that the one thing the not for profit hospitals are really good at is making money. 

I wonder how flexible the Edmond city council would be with a normal greedy businessman wanting to put up a larger sign?  Seems like it was a lot harder for the church next door to get their cross up than for the Integris folks to put up a sign that exceeded code.   Oh, well.  What’s one more monument to the corporatization of medicine?

G. Keith Smith, M.D.

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Canadians get better deal in Oklahoma…than Oklahomans!

Filed under: Uncategorized — surgerycenterok @ 3:07 pm

The Canadian surgical broker, Richard Baker, arrives this afternoon in Oklahoma City for a three day stay.  He will meet with various surgeons and physicians with whom he has had dealings over the last 5 years.  Rick and I have become friends, initially due to our mutual desire to help the patients he steers our way.  He also liked the fact that when he called my mobile number, I answered, then usually gave him a price for the requested procedure right then.

There is not enough space on this blog site to relay even a partial list of the horror stories he and I have encountered due to the rationing of care north of our border.  Oklahoma City has become his preferred destination for patient referrals.  Why?  Because the entrepreneurial spirit is alive and well in the physician community here.  Physicians, like the partners at The Surgery Center of Oklahoma, have put their money and capital at risk to provide a surgical experience for their patients that is second to none.  After all, if the patient care conditions aren’t exactly like the physician owners want them, who’s to blame?  The doctors are in complete control of the facility and the staff.  The doctors are in complete control of what the facility charges for this or that procedure.  There are many physician-owned and controlled facilities in Oklahoma and we compete with each other.  As I’ve said in previous blogs, it is the patient that benefits (both in terms of the quality of care they receive and the bruise to their pocketbook) when businesses compete in the free and open market.

Big “not-wanting-to-make-a-profit” hospitals work in a different way.  They make deals and enter into contractual arrangements.  These deals and contracts often times shut out their competitors, freeing them from the market competition and discipline any other business faces on a daily basis.  This lack of market competition has affected quality of care and blistered those paying hospital bills.  This model of propping up the profits of the giant hospital corporations is not sustainable and fortunately the market is in the process of crushing this corporate scam.  We believe that price transparency (like our posting of prices on our website) is like the rock in David’s slingshot.  Our posting of prices has revealed to the buyers of health care (whether self-insured companies or individual patients) that the highest quality of care is available for less than half the amount many insurance companies are contracted to pay our “not-wanting-to-make-a-profit” hospital friends.

Something else revealed:  Canadian’s are receiving their surgical care in Oklahoma City for a fraction of the cost that most Oklahomans are paying. I think that most folks are tired of the same broken arrangements and deals that benefit the usual suspects and are clamoring for an alternative.  The good news is that the market always responds to challenges like this and usually succeeds… unless some government thug gets in the way.

G. Keith Smith, M.D.

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September 14, 2011

Rick Baker: Harriet Tubman or Sir Percy?

Filed under: Uncategorized — surgerycenterok @ 4:05 pm

I’m having trouble deciding if Rick Baker (the Canadian health care broker sending us patients and visiting this week…see my last blog)  is more like The Scarlet Pimpernel, rescuing Canadians from the guillotine of rationing,  or a white, male, Canadian health care version of Harriet Tubman, helping the sick escape from medical bondage, navigate hostile territory and cross the border to obtain freedom from their medical conditions.

Disagree if you like with my analogy but what does that make the faith-based “not wanting to make a profit” facility here in Oklahoma City that refused these  medical refugees?

G. Keith Smith, M.D.

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Canadian Medical Tourism Pipeline to Oklahoma

Filed under: Uncategorized — surgerycenterok @ 2:22 pm

The Surgery Center of Oklahoma is proud to be host to Rick Baker starting tomorrow and lasting through Saturday.  His company, Timely Medical Alternatives, has thrived due to the type of government run medical system in Canada that the Marxist pigs in Washington want for us here.  You see, Rick helps Canadians find high quality, affordable and timely surgical care outside of Canada.  It is illegal to pay for your own private care in Canada, so Canadians who don’t want to wait 3 years to have their brain tumor evaluated (not operated but evaluated!!) go to him.  People with debilitating joint issues that don’t want to wait 3-5 years to get to see an orthopedic surgeon for a possible total joint replacement go to him.  Women with intractable uterine bleeding go to him rather than wait 2 years to see a gynecologist.  And what does he do?  He finds a surgical facility  and negotiates fair payment for a procedure that the patient and the surgeon agree is appropriate.  That a business like his even exists is evidence enough that the Canadian health care scheme is a failure.  That he has done extremely well in this line of work is indicative of the extent to which this failure has affected the lives of the Canadian people.

Why is he coming to Oklahoma?  He sends the vast majority of surgical patients to Oklahoma.  To our facility, to the Oklahoma Heart Hospital (which owes its success primarily to the physician owner and leader, John Harvey) and to the McBride Clinic Orthopedic Hospital.  Why these three facilities?  Why not Mercy or Integris?  You say,”..they are not for profit…they would give a better price than those greedy physician-owned and controlled facilities!”  Right!  Don’t make me laugh. All three facilities will provide transparent and fixed pricing for various procedures which the big “not wanting to make a profit” facilities will not.  Coronary artery bypass?  Fixed price.  Total hip replacement?  Fixed price.  Any of the procedures listed on our website ( at the price listed.

Canadians have benefitted in two ways.  Many have benefitted from the care they received at one of these three facilities.  Others have negotiated a price, bought their plane tickets then as they gave the appropriate hand gesture to their provincial health care bureaucrat, the Canadian health care system miraculously works them in and gets them fixed right up, in order to avoid the embarrassment of another patient disaster story.  In any event, we are happy to help these patients get care here or at home, unlike our local “not-wanting to make-a-profit” Catholic hospital that refused to grant care to these patients.

The Surgery Center of Oklahoma has provided care to patients from as far away as Nigeria and Turkey.  We have more and more patients coming to us from remote parts of the United States where health care is particularly expensive due to virtual monopolies of big hospital systems (California, Alaska and Maine, for example).  Having posted our prices online has afforded many patients the opportunity to receive reasonably priced care that they otherwise would not have been able to afford or receive.  Rick Baker has seen the value of our approach and increasingly so are many others.  Isn’t it ironic that the free market has found a way to provide care to those that the government has promised to take care of? We may  all be traveling to foreign countries to receive our care soon unless the states successfully push back the health care plan the Washington trash wants for us.

G. Keith Smith, M.D.

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September 10, 2011

Modern Life and Death of a Medical Practice

Filed under: Uncategorized — surgerycenterok @ 7:34 pm

Imagine that you are a family practitioner.  You went to college.  You majored in microbiology or chemistry and made all “A’s.”  You are the guy that no one wanted to be in class with because you would do whatever it took to make an “A.”  You would ruin the curve for anyone else in the class.  You got in to medical school and endured this four years of educational boot camp.  The first two years were about 6 years of graduate work crammed in to 2 years.  The next 2 years consisted of taking care of patients while sleep deprived and while some insecure (and sleep deprived) and by now psychotic resident berated you at every step.  You manage to graduate and find a good training program for your residency.  You work extremely hard and do well.  You begin to feel the incredibly satisfying feeling of using your knowledge to make a difference in people’s lives.  You pass your boards and move to a town that has been desparate for a doctor just like you.  You meet the daughter of a nice family in town and before you know it she is your wife and you have 3 children and are living the dream.  You have  a busy medical practice taking care of whole families.  You are delivering babies then watching them grow up in your practice.  Families from nearby towns actually travel to see you rather than go to their local yocal who is not nearly the physician that you are.   All is well. Then…

A large hospital chain that employees the physicians whose practices you have hurt through no action of your own other than provide great care,  decides to open a clinic in your little town.  You are scared.  You have a lot invested in this practice.  You have spent several years of your life to get to this point.  These hospital guys pay you a visit.  They tell you that you can go to work for them or they will bring 5 competitors to town to destroy your practice.  They tell you that they have seen to it that  you will no longer be on any of the insurance networks you have been on up to this point.  They tell you that this is all legal and consistent with their mission as a faith-based hospital chain.

You want to throw up.  You decide to take their offer.  They pay you about 20% less than you were making but absorb some of your overhead costs and malpractice insurance.  The contract is for two years.  About 6 months into it you realize that you don’t have to work as hard as you had been working in order to have about the same standard of living.  Things seem pretty good.  You miss having control of your practice, though.  You miss being able to not charge people who you know need a break from time to time.  You start to take vacations that you didn’t used to take.  Your paychecks continue coming in even though you are on the beach.  This is great.  Once in a while a patient complains that you aren’t as available as you used to be, but this doesn’t seem to bother you as much as time goes by.  The hospital chain brings the doctors they threatened you with to town anyway.  You don’t care much because you are being paid anyway.  You take even more time off.  This is a cush job!  You get to go to all of your kids soccer games and have time for golf and all sorts of woodworking projects.

Your two years on the contract is about up when the hospital guys show up to discuss renewal.  You’re already ahead of me on this arent’ you?  They offer…ready…half.  Half of what they had paid you the last two years.  Ouch.  Oh, and by the way, the malpractice insurance, should you decide not to accept our offer requires a “tail” policy that costs $100,000, as it doesn’t give coverage for past events that might crop up in the future.  Oh, and by the way, all of the patients that identified themselves as patients of yours now will now see anybody in the office and we have all of their medical records in our electronic system and you can’t take them with you if you leave.

So, that part of your practice that was “yours” is gone.  You have inherited a large insurance liability, one that you probably cannot afford.  You can’t affford the home that you are in now and can’t sell it in the current market.  The standard of living to which your family has become accustomed is gone.  You take their offer.  You lose your home in a foreclosure and use up all of your savings in the transition to your new down-sized life.  You hate your job now.  You become so bitter with how this has all ended up after all of your hard work that patients don’t want to see you anymore.

I wish I was making this stuff up.  For all the glitz, this is the real mission of our wonderful “not-for-profit” hospitals and their networks.

G. Keith Smith, M.D.

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No Tool, William Wallace, M.D.

Filed under: Uncategorized — surgerycenterok @ 7:28 pm

I know a guy who is a family practitioner.  He is a great guy.  His patients worship him.  He has fought the abusive hospital administrators that have tried to put him out of business from day one of his practice.  They have threatened him with all they had:  forming an insurance company and shutting him out…bringing other family practice doctors to town as hospital employees….you name it!  Yet he has resisted.  Slowly but surely, patients in his community realized that his practice was the one they wanted to be in.  He was their doctor.  He was their advocate.  Period.  He didn’t and hasn’t worked for a hospital…ever.

When his patients receive poor care in the hospital, he moves them to another floor of the hospital where the offending staff or nurse is removed from his patient.  He has actually moved patients from one hospital to another hospital!  He couldn’t do this if he was a tool. This advocacy is only possible because he is not a hospital employee.

I think I will tell him to paint his face blue when he goes to the hospital to make rounds.  We could certainly benefit from more like him.  Congratulations, my friend.

G. Keith Smith, M.D.

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Filthy Rich and Cold Blooded

Filed under: Uncategorized — surgerycenterok @ 7:25 pm

Imagine for a moment that you own a tire store.  A guy calls in and says he would like a new set of Michelin tires and would like to pay cash.  You say,”…no thank you.  We are not interested.”  What?  What kind of story is this?

That is exactly what happened at a local “not-for-profit” facility here in Oklahoma City.  A company that already sends medical tourists to Oklahoma City (to our facility and to two other specialty facilities) loves Oklahoma City’s central location and wanted to establish a relationship with a full service, large hospital here.  Keep in mind all of these patients are paying up front for whatever procedure they are going to have at rates that are profitable.  They are also people who are willing to travel a long way to get care because they are either in a Canadian waiting  line or live in some unfortunately backward place in Africa or Europe where facilities are not available or up to snuff.  Wow!  This is like a mission trip coming to you…you don’t even have to get all the shots for malaria to treat these people….and they are going to pay you up front?  And the facility that said “no” is affiliated with a church.  Ouch.

Why would they do this?  There is only one answer I can come up with.  They already have a ton of money.  They are focused on control at this point….power.  You see alot of guys that are bored billionaires that run for political office…same kind of thing…they have gobs of cash, they want to taste real power.  This hospital system and the folks that run it have demonstrated another point, though, by saying “no.”  They don’t care whether people get care or not.

I think they need to clarify their mission.  Make it more transparent.  Or maybe they just did.

G. Keith Smith, M.D.

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September 9, 2011

“Why so negative”?

Filed under: Uncategorized — surgerycenterok @ 9:24 pm

Some people say,”why are you so negative on your blog site?”

  “Why don’t you talk about happy stuff?” 

 ”Isn’t there anything good to talk about?”

Actually there is….and I have.  All that is good in medicine is that enveloped by free individuals acting on their own without coercion, either within the framework of a free market or as chartible actors.  If you have been following this blog you know by now that I clearly distinguish mutually beneficial exchange between free individuals from that of dealing with the muggers and thugs that hold us at gunpoint.  I have tried to clearly distinguish between acts of charity and acts of theft, the latter characterizing government action at every level.  I have tried to distinguish between the physicians who have taken their oaths seriously and continue to act in the best interests of their patients from those who are acting on other orders, be it that of their employer or that of the feds. 

If I seem to focus on the negative, though, it is because most physicians that I know are outraged by the injustice of the corporatist and government approach to health care which leaves the patient holding the bag.  Most physicians I know also would agree that most people we encounter are not aware of how we got to where we are.  Trash continues to pour out of Harvard University on “cost calculation” and “comparative effectiveness research.”  I feel like the best use of a megaphone (this blog) is to warn people about things that could cost them their lives.  Subsequent to that are the finer points of the free market and why we must focus on individual freedom and why that is important.  Imagine that you are a life guard at the beach.  The water is full of swimmers.  The water is full of sharks.  You have a megaphone.  It would not be appropriate to focus your shouts  mostly on what a beautiful day it is.

It is also difficult to talk about the positive side of health care without sounding too much like I am bragging on our surgery center.  There is a fine line between informing people and sounding too self-promoting.  There are incredible and wonderful things happening at The Surgery Center of Oklahoma but it is because of our unfailing devotion to the free market principles on which our organization was founded and to which we are committed.  Our wish is that every physician and facility will embrace the same principles.  Our wish is that everyone would embrace price transparency.  I believe that lack of this approach will result in the bankruptcy and destruction of those facilities and physicians who wish to cling to the current model of the cartelization of care…the corporatization of medicine.

My point is that while I am more optimistic than ever that market forces will prevail and that the wonders of modern medicine will be available at affordable prices in the near future, I firmly believe that those who stand to lose when this happens will act like cornered and injured animals, viciously attacking those threatening their scheme. 

G. Keith Smith, M.D.

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Sisters of Mercy Metastasis

Filed under: Uncategorized — surgerycenterok @ 4:54 pm

In an effort to continue to “not make a profit,” the Sisters of Mercy have descended like storm troopers on three more towns in Oklahoma:  Ada, Noble and Tecumseh.  I have always found it interesting that hospital administrators, just like the HMO peddlers, talk about “capturing patients.”  Maybe this is their idea of transparency, as this is probably an indication about how the people once locked in this health care cage really feel.  At the Surgery Center of Oklahoma we rely on our excellence in patient care to bring us business.  The greedy “Sisters,” rather than embracing the discipline of competition prefer setting up outposts and traps all over the state to funnel the sick to their lair.

The “Sisters” have been cramming cash into their habits on the backs of the sick and now are taking full advantage of their ill-gotten purchasing power.  The physicians that refuse to go along in these towns will be crushed and “shut out of the network.”  The physicians that become the Vichy doctors I’ve written about before and go along with the program will very shortly wish they had sold their home and moved their practice and family to another town.  These physicians, many family practitioners, pediatricians and internists, will be told under the usual strong-arm threats,  that they are to refer to surgeons and other specialists whose skills and/or ethics they know are questionable. Patients that have been in these primary care physicians’ practices that have become friends will wonder why they are sent to a different surgeon to take out their gallbladder than the one they loved who fixed their hernia.  After a few of the surgeries don’t go well, the primary care doctors will either become callous to their old friends and patients or they will leave this sick cartel.

Unfortunately, many patients will suffer unnecessarily while this unfolds.  These heavy-handed top-down planning ventures always fail after a period of time, however.  In the meantime, I offer my sincere condolences to the families of those victimized by this latest health care invasion.

G. Keith Smith, M.D.

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