Dr. Keith Smith
Dr. Keith Smith

By G. Keith Smith, M.D.

The “permanent” end to the yearly threatened cuts to doctors’ pay — the sustainable growth rate (SGR) formula — may satisfy my curiosity about what the end of a Ponzi scheme will look like.

All Ponzi schemes are unstable and doomed to fail. Medicare and Social “Security” will be no different.

The yearly postponement of SGR cuts was a bribefest held to tease and extort corporate health cronies and physicians. The “doc fix” was not an exception: just look at all the “stakeholders” acknowledged in its 263 pages.

The purpose of the SGR was to delay the bankruptcy and end of Medicare. The doc fix will hasten it.

Central to the progressive goal of controlling the practice of medicine — and to the success of the [Un]affordable Care Act (UCA) — is the need to push physicians into employment contracts with hospitals. As hospital employees, doctors are easier to control, and less able to act as uncompromising advocates for their patients.

Fear leads many doctors to succumb to “offers” of hospital employment they would otherwise not entertain. The threat of massive SGR cuts was a great fear generator.

There are many others: the imposition of electronic medical records on physician practices that could hardly afford them; the new diagnosis code maze-trap called ICD 10; RAC (Recovery Audit Contractor) audits conducted by hired guns of the Medicare Stasi that invariably result in the extortion of refunds.

With the doc fix, the government fearmongers and their cronies may have overplayed their hand.

A prominent part of the doc fix is an end to payments made directly to physicians. Hospitals will be paid, and the doctors will try to get paid by the hospitals. That the American Hospital Association lobbied so strongly for this provision should provide an indication of what they have in mind for doctors’ payment.

Another provision of the doc fix is called “outcomes-based pay,” wherein physicians are paid, for instance, based on how well patients do after surgery. To believe that the government and the Medicare apparatchiks actually care about quality and outcomes is to believe that “if you like your doctor you can keep him” now that the UCA is law.

This provision is particularly diabolical. Its true intent is the denial of care to the sickest and neediest (and likely the most expensive), as physicians fearing that they will be profiled for poor outcomes with sick patients will slow play their care or not see them at all. To bureaucrats, this provision has the added advantage of a built-in fall guy: the physician.

The physician who denies care out of fear of a soiled profile will be pilloried, while the real perpetrators in D.C. will celebrate and take credit for lower Medicare expenditures.

So what will happen? To grasp the importance of the doc fix, one must understand that practicing medicine in this country without participation in the Medicare program is a growing phenomenon, but has remained a step too radical for most physicians to take.

As Medicare patients are finding it harder and harder to find a doctor who will see them, the bold doctors who have seceded from Medicare have provided a source of medical care for this population, but have also served as a constant reminder that this socialized medicine program has failed the patients it was ostensibly created to serve.

If every physician dropped out of Medicare, Medicare would go away. Overnight. Physicians walking away from this scam amounts to a withdrawal of consent without which no government or government program can survive.

With the doc fix, more physicians will opt out of Medicare altogether rather than play the new “beg the hospital for payment” game that is inevitable. The supply/demand imbalance for Medicare “beneficiaries” will subsequently become more palpable than ever.

Stopping my involvement in Medicare in 1993 was the most liberating act of my practice, and all other physicians I know who have taken this step agree. This does not mean that physicians who opt out of Medicare refuse to see Medicare patients. It just means that the patients must “leave Darth Vader in the car when they come to the office.”

The D.C. gang that voted for a doc fix will get it, but not in the way they imagined. The way many doctors will “fix” their new problem will be to quit dealing with Medicare altogether.
Now that Congressmen have auctioned off their votes to the cronies, I say follow Murray Rothbard’s advice and Gandhi’s example: physicians, withdraw your consent and opt out of Medicare altogether, refusing to play by these rules.

Once Medicare “beneficiaries” realize that they have “coverage” but little access to care, they will demand an alternative to this confidence trick. Physicians who welcome them will benefit all, including the unborn whose futures have been mortgaged to perpetuate the scheme.

Dr. G. Keith Smith is a board certified anesthesiologist in private practice since 1990. In 1997, he co-founded The Surgery Center of Oklahoma, an outpatient surgery center in Oklahoma City, Oklahoma, owned by 40 of the top physicians and surgeons in central Oklahoma. Dr. Smith serves as the medical director, CEO and managing partner while maintaining an active anesthesia practice.