Medicare, Docs and Dr. Smith


Dr. Keith Smith is the medical director, CEO and managing surgical center partner of The Surgery Center of Oklahoma.  His concept is revolutionary.  They do only cash and all the prices are listed!  I met Keith a few months ago and really respect him.  Here is an editorial he did.  I liked it so much that I thought I would repeat it here.  

The ‘Doc Fix’ and the End of Medicare

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.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  4 comments for “Medicare, Docs and Dr. Smith

  1. Steve O'
    May 3, 2015 at 8:53 pm

    I disagree with one comment. The Stasi were well-organized and competent – don’t drag them into this as an example.

    • Pat
      May 3, 2015 at 9:11 pm


  2. Perry
    May 3, 2015 at 4:21 pm

    “Quality care” = rationed care.

  3. Pat
    May 3, 2015 at 11:54 am

    Fantastic column by Dr. Smith that perfectly describes the scene. I hope his optimism in a final outcome is borne out, and I hope my pessimism is proven wrong. Presently I still believe that when a critical mass of “deserving seniors” cannot find a Medicare doc, the feds will force the states to force doctors to participate in this deceitful, dehumanizing program.

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