The government is now paying some hospitals “not” to train resident physicians. Uncle Sam has the uncanny ability to pay the same amount of money for providing a service as for not providing one.

Some time ago a family physician mentioned to me that he always had an internist or surgeon take care of his patients in the hospital. He was not able to provide daily hospital care. In fact he normally saw his hospitalized patients only twice a week. His office just automatically entered a hospital charge on Tuesdays and Thursdays for his hospital patients since on those days his scheduled stopped an hour earlier to allow him time for hospital rounds. Once, because of family obligations, he saw the patients Mon, Wed, and Friday after work. Unfortunately he failed to tell his office which then failed to change the date of service… On medicare audit, he was charged with Medicare fraud, and was about to be cited and fined, for charges on this patient for a Tuesday and Thursday evaluation that did not occur. He pleaded that he had actually seen the patient three times rather than twice and that medicare really saved money. Uncle Sam’s position was that not charging for Mon, Wed, & Fri that week was his choice. But charging for Tues & Thurs and not seeing the patient was fraud. It cost him about ten hours of legal fees for his attorney to straighten that out.

When I did my training in Michigan, there was a referendum for farmers to vote on whether they wanted price supports, an artificially high price for grain, to compensate them for not growing grain. It failed by 80 to 20. However, Uncle Sam enticed individual farmers to sign up for price supports. Gradually most farmers were induced to obtain funds for not growing grain. Payments gradually increased so that some corporate farmers were making nearly a million dollars by not working a portion of their land.

Tobacco farmers had the same inducements. As the epidemics in strokes, heart, and lung diseases related to smoking reached astronomical proportions causing huge medical expenditures, some state governments are trying to sue the tobacco industry to recoup their health care losses. Uncle Sam, however, continues to subsidize the tobacco farmers with price supports.

Tim Draper of Redwood City in a recent column reports on the “technology summit” held near Palm Springs. A lawyer and three lobbyist suggested that Silicon Valley should build better relationships with Washington. They should educate politicians and bureaucrats. The response: Our industry now accounts for 11% of the gross domestic product, employing 4.2 million people who earn double the average salary of similar workers, making the US the world’s most competitive economy. They pointed out that the industries that had done the “best job” of lobbying and teaching Uncle Sam about their business are among the most heavily regulated and the least attractive investments. Teaching folks inside the Beltway about our business is a dumb idea, he says. He explains that one must understand the mind of a bureaucrat who lives to regulate and make rules to justify his existence. One must also remember the success of your industry is not very important to him. Draper thinks they have done just fine without Uncle Sam and are anxious to keep him 2500 miles away so he doesn’t raise barriers to information. He states that without regulations we’ve even come up with an alternative to the post office and the phone company: E-mail.

The number of patients who spend their entire day on the internet seems to be increasing. Some spend 12-15 hours a day at their computer keyboard. The Wall Street Journal reports that some of the porno lines on the World Wide Web are having problems with password promiscuity–the sharing of passwords with friends for only one monthly fee… Reminds me of the psychiatrist who was listening to a patient talk about having sex online. The psychiatrist mentioned, “That must be one form of safe sex.” The patient said, “I don’t know. It seemed very real to me. And I wasn’t even wearing a condom…” Our president can’t stand the freedom of the internet. He wants Uncle Sam to regulate it. Maybe we all better get online quickly. It might be the only thrill left in life.