Surgery Center of Oklahoma Blog

We call the insurance company and do our part.  The company authorizes payment for the surgery in question.  We perform the surgery at a price less than half that of the hospital this insurance company tries to force patients to go to.  The insurance company doesn’t pay us.  Sounds like a great way to make money if you ask me.  Collect premiums and don’t pay claims.  This is an incredibly successful strategy for making money!

Now the patient is responsible for the bill.  The patient is furious as they should be.  And they are furious at the insurance company.  This hasn’t always been the case.  Patient’s used to take their anger out on us but the abuses of certain insurance companies have become so commonplace and people are much better informed so they direct their anger where it belongs.  Angry patients are much more effective than collection agencies.  We typically get paid soon after the patient throws a fit.

What will happen when the government is the  only insurance “company?”  There won’t be any concern on the government’s end that they had better handle some patient issue or there will be hell to pay.  There won’t be any concern that “we might lose business or a customer.”  There won’t be any concern at all.

Is there a place for health insurance?  Sure there is.  But they should be subject to the same market forces that discipline the rest of us.  They have lobbied hard and received many protections from the federal government to free them from that discipline and that is part of the problem with medicine in the US.  One way or another, when the government gets involved, they screw things up.

Our prices at the Surgery Center of Oklahoma are lower for patients who either don’t have insurance or save us the trouble of messing with their insurance company.  The lack of risk of not getting paid as described above is part of the reason we have such discounted pricing.  What business, other than health insurance companies, could conduct business this way and stay in business?

G. Keith Smith, M.D.

Until the mid-1990′s Medicaid was administered by the DHS here in Oklahoma.  Medicaid now is administered by the Oklahoma Health Care Authority.  How and why did this shift happen?  David Walters, the governor of Oklahoma, in an effort to ingratiate himself to the newly elected president (B. Clinton) and in anticipation of Clinton’s health care plan passing, brought a young socialist physician, Garth Splinter, to town to set up a “health exchange.”  Heard this phrase before?  The Canadian model was the “best health care model on earth” we were told by Dr. Splinter (that’s why so many Canadians travel to Surgery Center of Oklahoma for their surgery!)  Splinter set up the Oklahoma Health Care Authority, once again, in anticipation of Clinton’s health care plan becoming law.  Jumping on board early was supposed to boost the likelihood of Governor Walter’s securing one of those cushy Washington jobs…maybe even one in the White House.

Slowly but surely, this “Authority” began to assume more and more of the functions of the DHS and lo and behold, there were redundancies.  What?  In government agencies?

Recently the head of the “Authority” has been in the paper for his large compensation and  bonuses (due in large part to his having secured the provider tax deal….SWEET).  His compensation has been characterized as scandalous in the face of actual cuts in services to the poor.

Here’s a radical idea for you budget cutting types in the state legislature.  Why not abolish the “Authority?”  Give Medicaid back to the DHS.  This would not only save money but would eliminate an agency that could easily be confused for just the type of  ”exchange” that the current tyrant in charge of Washington is looking for.

I’m not holding my breath.  Maybe if the legislature abolishes the “Authority” they can then abolish the new and wonderful “Business Activity Tax.”

G. Keith Smith, M.D.

This is an easy one.  You don’t have a right to health care.  Maybe I should end the blog right now.

Oh well, I’ll see if I can explain it for those who aren’t laughing out loud right now.  You see, it all depends on how you define “right.”  If by exercising a “right” you violate the “rights” of another….well….then you don’t have the original “right” you thought you had.

If you think you have a “right” to a hernia repair and it ought to be “free”(whatever that means?!) you have neglected to consider the robbery (taxation) of the folks down the street needed to fund the manufacturers of the materials and supplies needed to complete your surgery (kind of a demented version of Bastiat’s “what is not seen!).  Or how about the people providing the service?  Does an obligation exist for them to provide you this service just by virtue of their having the skill to get it done?  Someone’s property rights had to be violated for you to exercise your “right.”  With me so far?

How about this one?  If the surgeon is performing this surgery (with no benefit to himself) with a gun to his head, do you think he really wants to be there?  Do you think he cares about you?  Might this possibly affect the care that you receive?  DUH!!  Trust me….you want your surgeon to care about you!

You don’t violate anyone’s rights when you breathe air.  You are not denying anyone’s access to air if you breathe.  You don’t violate anyone’s rights when you speak in a public square about poetry.  But when you make me provide your anesthetic on terms that I deem not mutually beneficial, you have violated my rights.

We have an obligation to help our fellow man as we can.  This is the almost forgotten concept of charity, taxation having almost entirely taken its place due to limited (not infinite) resources.  The recipient of our charity doesn’t have a right to our goods or services, but we are all free to bestow whatever gifts we have on the needy and we should.  I believe there is a difference, however, between charity and theft.  Do you see this distinction?

G. Keith Smith, M.D.

Should Medicaid (welfare) pay for facelifts?  Should Medicaid pay for cosmetic breast augmentation?  Most of you reading this would answer, “no…are you kidding?!”  Well, you’ll be glad to know that currently Medicaid doesn’t pay for these procedures.  But there are some medical procedures they do pay for that cost the taxpayers of the state a lot of money and are…well….unnecessary.

How about epidural anesthesia so the birth of the Medicaid patient’s baby is wonderfully painless?  Should Medicaid be paying for this?  I think about the days when I did OB anesthesia and saw the 19 year old unmarried girl having their third child insisting on a labor epidural so that the experience would be painless (not tolerable, but painless).

Why not have these patients pay for this out of their own pocket (if they can’t afford it, their family can pool their funds for this luxury)?  This would save the state a lot of money and the anesthesiologists in the state would be wildly in favor of this.  Whenever I hear that it is difficult to come up with ideas for budget cuts here in the state I wonder just how much thought is given to the extent to which money is wasted on things like this.

I recently had a friend scheduled for an unnecessary surgery here in town.  The surgeon is known for his lack of judgement and marginal-absent skills.  Widely known.  Fortunately for my friend I found out what was going on and intervened.  She saw a competent surgeon and was diagnosed and treated in his office.  At what physician-owned surgery center does this buffoon work?  Ready?   He doesn’t work at one.  What?  ”I thought all you doctors were interested in was money?  Why wouldn’t you want someone like this working in your facility making lots of money,” you say?

Because he is trash.  What he is doing is unethical and it makes everyone he is associated with look like trash including the doctor (a hospital employee)  that referred my friend to him and the large hospital that continues to renew his privileges.

But there is more.  This surgeon scheduled another unnecessary surgery last week.  There is just one problem.  The patient is the son of a prominent physician here in town.  The patient’s father is not one to take this lying down.  This situation could be lethal to the career of the idiot surgeon.  This situation will be embarrassing to the hospital that continues to renew the privileges of this guy.   Wouldn’t surprise me if this winds up before the licensure board.

If you need surgery, ask the surgeon what physician-owned surgery center he works at.  If he says he doesn’t work at one……I suggest you run.

G. Keith Smith, M.D.

The NEA has just endorsed the current occupent of the White House for president in 2012.  I suggest that the teachers that are members of this organization should try out Obamacare first and let the rest of  us know how it goes.

G. Keith Smith, M.D.

Should taxpayers be forced to fund medical research?  Should taxpayers be forced to fund any research at all?  The academic researcher would say (and has said), “if government doesn’t fund this who will?”  As more and more people are “looking behind the curtain” and finding that national bankruptcy is actually possible and budget cuts are unavoidable, brace yourself for the whining and gnashing of teeth from those who have been gorging themselves at the medical research trough.  See my 1995 letter here.  This comes up from time to time because honest physicians periodically scratch their heads after reading an article in a medical journal and wonder,”So? So What? What relevance does that piece of research (funded by a government grant) have to my practice….or to anything for that matter?”  It seems that lately, the shame associated with frivolous research done as a manifestation of expert grant-writing with little or no purpose at all, is gone.  Academic research departments have expensive labs and staffs and increasingly their eyes are on the next government grant, not on any particularly useful discovery.  Currently, some research department revenues support the academic clinical practice (taking care of patients) while in the past it was the other way around.  Common sense, huh?  If the government pays more for research than for taking care of patients, well, you get more research, right?  I guess my point here is that without the market driving research we are more likely to get research for the sake of research rather than research geared toward results.  I include private charitable foundations in the term “market” because the funds are not confiscated from taxpayers and thus are not politicized.

The politicization of research, an unavoidable result of government funding, has consequences.  Lobby’s and lobbyists spring up with pressure groups.  Politicians are painted as demons unless they “care” enough about this or that disease to “fund” research.  Diseases without lobbies go to the bottom of the list.  The search for a cure for this or that disease is a long process, but almost guaranteed to last forever if discovery of a cure ends your federal funding!

Here is one way  it might go:  a drug company makes large donations to the political campaign of one of the derelicts in Washington.  He leans on members of a committee in charge of funding some government grant-giver to award a lab (at an academic institution also benefitting from the largesse of this same drug company).  That academic lab does a study (and is paid nicely for this) that determines that this or that new drug (made by the above drug company) is indeed safe and effective.  What?  You think that this doesn’t happen?

How much more research money would the global warming guys get if they determined that the data showed that the earth’s temperature hadn’t significantly changed?  Maybe that’s why researchers at the East Anglia Climate Research Unit withheld data that led to this very conclusion.  See here.

Taking the market out of the research process has consequences just like taking the market out of anything.  There are mal-investments and distortions.  Research is done in one area that could (or should) have been done in another.  Failure to make discoveries is often rewarded with even larger grants.  I am anxious for this distortion to end and await the end-of-the-world arguments and whining from those cut off from this funding when it does end.

G. Keith Smith, M.D.