The Regulation Firestorm and Medicare

I did my initial medical training in pre-Medicare days. In those days there was the private service and the ward service where patients who could not afford to pay were treated free of charge in open wards by physicians in training under supervision. Medicare started between my internship and my residency. We liked the wards but the fickle patients abandoned us in droves for the private hospitals and experienced doctors. So it was pretty obvious that Medicare filled a need. But Lyndon Johnson and the Democrats had their sights set on a larger target than just helping the needy and so we had a government takeover of medical care for everyone over age 65. Doctors were skeptical but were in the end bought off, and probably did not have the political power to resist in any case.

The Medicare law provides specifically that: "Nothing in this title shall be construed to authorize any federal officer or employee to exercise any supervision or control over the practice of medicine "

What a blatant falsehood this has become! We are hearing a lot these days about the negative effects on the private sector of excessive government regulation and in this regard the healthcare industry tops the list. For medical practice, Medicare has become a regulation nightmare, producing such high cost and complexity as to be rapidly driving doctors from independent practice to salaried jobs with hospitals and large medical conglomerates.

Since seniors use a disproportionately high amount of medical services, and since all their services are governed by Medicare regulations, Medicare is a dominant force in most medical practices. Payment by Medicare for doctor services is through a byzantine system, with multiple different payment levels each requiring detailed documentation of voluminous extraneous material mostly having nothing to do with the problem at hand. And for the past few years all this documentation must be done by complicated highly regulated computer programs costing an average of $30-35 thousand per doctor requiring thousands more each year for maintenance. Moreover compliance requires medical practices to hire added personnel such as billing and coding specialists.

It would be one thing if such regulations produced improvement in patient care, but instead they are making things far worse. In addition to increased cost they are diverting doctor's time to administrative busywork instead of patient care. Medical records have become a mass of bureaucratic jargon, filled with sometimes erroneous material of no importance. Major new regulations are scheduled to start on January 1st supposedly to improve the quality of medical practice. Quality is to be judged by even more documenting and reporting. But this is nonsense. The quality that patients value more than anything else is the time and attention of the doctor.

This regulation firestorm is becoming bizarre, the stuff of Alice in Wonderland and Franz Kafka. Sadly there is no way to characterize it other than government oppression. And it is becoming intolerable to the point that a small but increasing number of doctors are taking the risk to opt out to DPC, direct patient care, which will be a matter for another time.