Paul Craig Roberts was Assistant Secretary of the Treasury during President Reagan’s first term. He was Associate Editor of the Wall Street Journal. He has held numerous academic appointments, including the William E. Simon Chair, Center for Strategic and International Studies, Georgetown University, and Senior Research Fellow, Hoover Institution, Stanford University.
Paul Craig Roberts
At my annual check-up, my doctor handed me a sheet explaining the reasons for office fee increases for Medicare Patients. It is worth reporting at length.
Medicare fixes the prices for Medicare patients’ health care. All office charges for Medicare, including office visit charges, have been set by the Federal government since 1984. In real terms (adjusted for inflation), these fixed prices are less today than they were three decades ago.
During the last four years, there have been large decreases in Medicare reimbursements for laboratory services provided in-house by private physicians. Payments for in-office blood work, for example, have been cut 35 to 47 per cent. Yet, a physician’s overhead continues to increase as a result of uncontrollable costs, such as property taxes, building insurance, electricity, maintenance, malpractice and workers compensation insurance.
As one result, my doctor had to close both the x-ray unit and the state and federally licensed medical laboratory on his premises. Now patients are inconvenienced by having to go to other locations for services that formerly were provided by the doctor at lower cost. A one day medical check-up is now a multiple day event and more expensive.
While Medicare payments to doctors have been cut, regulations have been increasing: “Almost every outside diagnostic procedure (CT, MRI scan, sonogram) ordered by this office now has to be pre-approved by some outside agency. Many medications are now requiring pre-approval or step therapy. Each requires filling out 1-2 pages of forms and/or two or more phone calls. This requires personnel time and therefore more cost. Consultant referrals are requiring more paperwork and time to schedule.”
My doctor has more people employed doing paperwork than he does delivering health care.
While Medicare payments for in-office services to private doctors, including those for blood work and x-ray units, were drastically cut, payments to outside corporate facilities for the same services were increased. It is obvious what is afoot. Corporate lobbies are using their whores in Congress to shift income from physician offices to corporate labs, corporate medical service providers, and hospitals that are owned by national corporations.
Legislation that cuts payments to private physicians and increases the payments to large corporate entities is intended to destroy private practice and to create in its place corporate bureaucracies in which doctors are wage slaves. The physician’s income is diverted to shareholders, CEO bonuses, and Wall Street. Health care is being replaced with health business.
As a result of the way American medicine is being reconstructed, patients will cease to have a doctor whom they know and who knows them. Important information is lost in a system of bureaucratized “health care” in which a patient sees whatever face happens to be on duty at the corporate provider. Impersonal health care thus brings a cost of its own, and its quality can be low compared to private practice. Indeed, the U.S. is creating a “health care” system that is more costly and less efficient than single-payer national health systems. But it will enrich corporations and provide play for Wall Street.
It turns one’s stomach to watch libertarians and “free market economists” defend bureaucratized impersonal health care as “free market medicine.” There is no free market present. Corporate lobbies and campaign contributions use government power to create bureaucratized monopolies that destroy medicine for the practitioner and the patient. Wall Street pushes for greater shareholder earnings, which are achieved by denying care.
Just as independent businesses have been destroyed by corporate chains from Wal-Mart to auto parts to fast food, medicine is being destroyed by monopoly capital. The risks of starting a private business today are many times higher than they were a half century ago. Chains have turned Americans who once were independent business men and women into employees.
The fate of the health care bill demonstrates the power of private lobbies. What was to be health care for Americans was instantly transformed into 30 million new patients for the private health insurance industry. The “solution” to tens of millions of Americans being unable to afford health care is a law that requires them to purchase a private health care policy or be annually fined. As most of these uninsured Americans cannot afford to purchase a private policy, the plan is for the federal government to use taxpayers’ money to subsidize their purchase of a policy from private companies.
In other words, tax money is being diverted to the pockets of private businesses. This is par for the course in “capitalist” America.