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A Voice for Private Physicians Since 1943

The Dry Tortugas and Being a Deplorably Good Physician

By Marilyn Singleton, MD, JD

Hillary Clinton recently said that half of Donald Trump supporters belonged in the “basket of deplorables” and were irredeemable. Many believe that Dr. Samuel Mudd, the physician who treated John Wilkes Booth, was deplorable. While some say he was merely being a good doctor, setting a broken leg for a man in pain, others argued that he knew of the conspiracy to assassinate President Abraham Lincoln. After a speedy trial, he was sentenced to life imprisonment at Fort Jefferson on the Dry Tortuga Island off the Florida coast.

An 1867 outbreak of yellow fever took the lives of prisoners and the prison doctor. Dr. Mudd took over and saved some 1000 lives. Conspirator, maybe. I’d like to believe he sought redemption and his physician better angel emerged and he did what he was trained to do: take care of patients. After laudatory letters from the prison and continued local advocacy, Dr. Mudd was pardoned by President Andrew Johnson in 1869.

Over the last few years we have seen the deplorable consequences of the Affordable Care Act. Most of the newly “insured” are folks placed on Medicaid. There is a reason Clinton calls for “Medicare for all” and not Medicaid for all. Then there’s the lack of choice in insurance policies and the consequent lack of choice of physicians; unaffordable premiums and sky-high deductibles for virtually unusable insurance, and mergers of major insurance companies, further lessening choice.

A new study looking at California hospitals shows that as more hospitals become part of large chains, the prices go up – as much as 25 percent. As more hospitals consolidate, this trend is likely to be replicated across the county. Again, less choice and competition have their consequences.

With regard to medications, competition in stores like Walmart some ten years ago caused cash prices to be much lower than deductibles. But now many pharmacists are barred from discussing the cash price under terms set by contracts between them and the middlemen-insurers.

And as for that doctor that you liked but couldn’t keep, the government has doubled down on the red tape to receive compensation for treating Medicare patients. The 962-page Merit-Based Incentive Payment System (MIPS) forces your doctor to complete reams of paperwork showing compliance with complex metrics or they will get a downward “adjustment” of their Medicare payments.

Particularly troubling is the “Resource Use,” measurement which begins as 10% of the score and increases to 30% in 5 years. This metric measures the cost per beneficiary based on the government’s review of claims submitted. But this metric does not address the fact that patients have different needs. Some patients may require more visits for the same illness.

Worse yet, the new system spells the demise of our beloved solo practitioner. The Center for Medicare and Medicaid Services estimated that 87 percent of solo practitioners would be penalized.

Government regulation has reached the tipping point. Even the citizenry of progressive Seattle, Washington had their limit. The city authorized a plan to impose a $1 fine on residents each time their garbage cans were filled with more than 10 percent food, compostable waste and paper products. Trash collectors were forced to snoop through the garbage to ensure compliance. A lawsuit was filed and the ordinance was deemed unconstitutional.

The regulatory escalation confirms that the ACA and its progeny were about control, not improving medical care. As more patients complain about unaffordability and inaccessibility, the answer from the social engineers is to say we have to just make health care free! But experience with human nature shows that paid products carry more value. Physicians want patients to value their health. Physicians want to care for patients, not become paper-pushing robotic “providers.”

There is another answer. Physicians can break out of the third party payer trap. We have learned the hard way that if you take their money, you follow their rules, no matter how restrictive or onerous. The majority of patients would pay for routine care, the cost of which is far less than the current insurance premiums. Remove the ACA’s restrictions on insurance policies for catastrophic illnesses. These policies were inexpensive and available to all. Finally, let physicians get back to delivering unfettered charity care.

Remember, the core of Mrs. Clinton’s 1993 Health Security Act was to “put the common good, the national interest ahead of individuals.” Mrs. Clinton’s plan massively expanded the health care fraud definitions and penalties. Physicians faced $50,000 penalties for rendering care outside of the system or seeking payment for care that did not comply with her National Health Board’s medical necessity standards.

In Clinton’s eyes, if you are a patient seeking individualized care or a private physician, your name is Mudd.

Dr. Singleton is a board-certified anesthesiologist and Association of American Physicians and Surgeons (AAPS) Board member. She graduated from Stanford and earned her MD at UCSF Medical School. Dr. Singleton completed 2 years of Surgery residency at UCSF, then her Anesthesia residency at Harvard’s Beth Israel Hospital. While still working in the operating room, she attended UC Berkeley Law School, focusing on constitutional law and administrative law. She interned at the National Health Law Project and practiced insurance and health law. She teaches classes in the recognition of elder abuse and constitutional law for non-lawyers.

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