Surgery Center of Oklahoma Blog

October 18, 2011

The Market is a Harsh Mistress: Apologies to Heinlein

Filed under: Uncategorized — surgerycenterok @ 8:54 am

Here’s a good one for you.  A physician I know who continues to deal with Medicare discovered that he had been accidentally overpaid by them for a particular patient.  He notified the Medicare carrier of their mistake and informed them that he would refund the overpayment promptly.  He got a letter.  The first paragraph acknowledged the mistake and recognized his refund as the solution.

Second paragraph. Ready?  ”….this refund of the overpayment made to you does and will not protect you from future prosecution.”

This should help you understand why fewer and fewer physicians are willing to see Medicare patients.  I’ve said before that it is no coincidence that Medicare is the only insurance company that has its own F16′s and tanks.  The good news for the elderly is that as fewer and fewer physicians deal with Medicare, paradoxically more and more of them will be available to see the elderly.  As Medicare unwinds due to its inevitable bankruptcy, the market will perhaps be allowed a chance once again in the delivery of health care to the current elderly.  Don’t forget that Medicare and the concept of health insurance is a fairly new thing.  In the 1950′s surgery for hip fractures and C-sections for child birth were very affordable events, the payment for which came directly from the patients or their families and without the involvement of insurance at all.

The return to rational pricing in health care is a real possibility, I believe.  The market must be given a chance, though.  The introduction of market discipline into this economic health care mess begins with transparent pricing.  If you are following this blog, you know that is exactly what we are trying to do here at our facility.  As we attract more business, our competitors will be forced to offer price transparency, not because of some government mandate, but because the harshest disciplinarian of them all, the free market, will force them to post prices or lose all of their business to those who do.  As prices fall and the quality of care improves (both natural consequences of competition) the fear of bankrupting medical bills will begin to subside and the importance of insurance for health care will begin to fade.

This is all good news.  It is particularly good news for the elderly and the poor, as without events unfolding as I have outlined above, the already scarce resources will be rationed out to fewer and fewer of the sick and more and more patients will go without care.  This “good news” message was the one I recently delivered in Washington D.C. and was well received.  This message is not good news for everyone, however.  Those who profit from the current unsustainable scams and those bureaucrats who would need  to find a new line of work are not pleased with what I had to say.  The scams and shell games are finding fewer places to hide, though, and like it or not the market will deliver in spite of all the attempts to stop it.

G. Keith Smith, M.D.

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