- Del Meyer, MD - https://delmeyer.net -

At the Public Trough – I got what I wanted, did you?

During Career Day in High School, another student and I went to our local family physician to see what medicine was all about. He showed us his office, discussed a few patients, and showed us his books. He charged $1 for an office call. When I went to medical school, he told my parents there would never be another charge for taking care of them for the rest of their lives. He called it professional courtesy to a colleague’s family.

During my preceptorship with a family physician in a rural town of Kansas, when a patient couldn’t pay, the doctor didn’t enter a charge. He was generous in not recording a charge for many patients who obviously were poor or by canceling a charge on a patient who alleged financial difficulty. There was one or two such patients every day. Office calls were $2. This doctor said he made plenty of money to live in a nice house and buy a Pontiac when most of the town drove Chevies. He even got his wife a credit card. It made her happy and that made him feel good.

When I came to Sacramento in the 1960s, a neurosurgeon said he never charged the poor or retired for craniotomies or back surgery. He made enough money from the workers who paid cash or with a Blue Cross/Blue Shield card.

When Medicare and MediCal came into being in 1966, the need for this charity was lessened. Many felt these services helped to provide care for the less fortunate. The cost of providing care, however, greatly increased with the inflation that Medicare and MediCal caused. But if the reimbursement was only half of the fee, it covered the half that paid the expenses. Thus, the doctor could donate his time unencumbered by the cost of the practice.

Some physicians didn’t accept government re-imbursement, feeling it was unethical. Dr Sanford Marcus, President of the Union of the American Physicians and Dentists (UAPD), stated in an address to the Sacramento Society of Internal Medicine (SSIM) that when some of his patients brought in those little MediCal stickers that he was supposed to apply to an insurance form to get paid, he told them to keep those pasties and he would continue to take care of them for the rest of their lives or as long as he was in practice. Marcus also felt it was un-professional to place those little pasties into little boxes on an insurance form. As I recall, he hadn’t pasted anything like that since the second grade in school, and he knew someone under the capital dome was having a big belly laugh at what they had gotten doctors to do.

Recently there was a discussion in the staff room about our leadership asking the legislature for fee increases for MediCal patients. Most were at a loss as to how this could be otherwise. This is unfortunate. As a profession, should we be at the “public trough?”

As MediCal reimbursement slipped from 50% to 40% of the fee structure, many physicians were unable to take on new MediCal patients but kept the ones they had. When reimbursement slipped to 30%, even fewer were accepting new MediCal patients. At this point, some of our leaders felt we should go to the legislature to “help” the poor. However, that gives the public an image that we are at the “public trough” asking for money. Even the MediCal patients don’t understand why we should be asking for more money. Private HMO patients already feel that their $10 co-payment is the full cost of an office visit and is more than it should be.

The best service we can provide, is to let the market handle the problem. As more MediCal patients can’t get care, they automatically call their senators and assembly person. These office holders, always anxious to please the electorate, will figure out that the MediCal reimbursement rate is the bottleneck. They will loosen the bottle neck in a few days, if not hours, by an emergency increase in re-imbursement, so MediCal patients will be seeing their doctors and not calling the officials.

Isn’t it better that the patients requesting services are at the public trough, rather than the professionals? The legislature, the public, and our patients will no longer see us as the people with their hand out for taxpayer money. And when we go to the market, or the theater, or a restaurant, we won’t have to defend our medical associations as being more than a trade organization or lobbying group.