Just a Start

Even as Medicaid is busting state budgets sea to shining sea, organized medicine led by the AMA, concerned advocacy groups, and the at least half of elected officials are pushing to expand the program (and California would like to expand it to large chunks of Latin America).

Medicaid paperwork and reporting requirements continue to enlarge, and states remain under pressure to increase eligibility, and reduce payments to physicians and hospitals. Participation is for many doctors, minimally profitable if not a downright money loser.

Should participation in Medicaid be an individual decision for the practitioner, based on what he thinks is best for his bottom line and according to the dictates of her own conscience?

 Not according to New Hampshire legislation HB 693-FN. 

• “A health care practitioner may opt out of the provisions required by paragraph I by paying an annual fee of $10,000 to the department.  Facilities may opt out of the requirements of paragraph I by paying an annual fee of $10,000 per full time professional staff equivalent to the department.”
• ” The commissioner shall conduct an annual audit of health care practitioners and facilities, including outpatient facilities.  Based on the audited data the commissioner shall calculate the ratio of Medicaid and uninsured procedures to other compensated procedures.”

Much as we like to think of private physicians as free, independent citizens, even DPC docs are de facto agents of the state that controls their licensure.  And now one state seeks to audit their docs to make sure they are sufficiently cooperative, on pain of financial penalty.  If they use any of the extorted monies to bonus providers with above-average Medicaid participation, it will have the added benefit (again) of pitting doctors against each other.

I was predicting this 15 years ago, and I’m only surprised that it has taken this long.  Whether or not the Granite State passes this, expect similar bills to pop up around the nation, especially in states with looser Medicaid eligibility requirements (and not coincidentally, lower payments to doctors).  Where such bills pass, more state auditors will be bothering physicians, some of whom will simply play ball.  Others will be more creative.  It might be easier to assign managed care Medicaid patients to “exclusive” hours, say 2-5 pm on Thursday afternoons.  That will work for a while, until the complaints finally catch up with the malcontents. 

In the shorter run, this will be another way to force doctors to work more, for less pay, in the name of some nebulous “fairness,” defined by the sort of voters for whom Medicare-For-All makes sense.  It will drive more physicians into retirement, and be a sort of jobs program for up and coming LELT’s.

 In the long run, this too will help set another girder for fully nationalized care, and all the coercion and apathy that is to follow.

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