We live in an age when the secretary of the Interior and the White House press secretary proudly and publicly proclaim that they will keep their “boot on the neck” of an oil company. This new manifestation of “hope” and “change” is ominous at a time when the government is rapidly escalating its involvement and control of all aspects of American society. That is especially true in the health care arena, but anyone with a neck should be concerned.
If you have been wondering how the health care legislation enacted this year will work out in practice, there has been a strong early indicator from Idaho. Eric Holder’s Justice Department has used the Antitrust Division’s civil action and criminal prosecution powers to force orthopedists to accept government reimbursement rates for their services. Accepting anything other than the government rate is considered a criminal conspiracy against market pricing.
How is that? The Department of Justice declares that “government prices are market prices.” The Idaho Orthopedic Society is guilty of criminal conspiracy to fix prices if its members charge anything other than the price fixed by the government.
By the way, these physicians have also been told that they must accept rates paid by Blue Cross and set by the Idaho Industrial Commission for workers’ compensation claims.
In the Orwellian world of the Justice Department, if physicians decide on a price, they are engaged in a criminal conspiracy, and if the government forces a price on everyone, that is a “market price.” When the clear meaning of words is replaced with government fiat in this way, all limits on arbitrary government power and its use of force are destroyed.
For two generations the U.S. government has reimbursed physicians and hospitals for less than the cost of treatment for Medicare and Medicaid patients. In addition, physicians who treat Medicare patients are forbidden from charging them for any service not covered by Medicare. These inequities result in the shifting of costs to other patients and private insurance companies.
While providers who decline to treat Medicare and Medicaid patients have not been charged with criminal penalties (so far), the threat to further reduce reimbursements serves as a powerful weapon for politicians to rake in funds. They effectively turn organizations like the American Medical Association into public employee unions focused on getting their share from the government.
The ground was laid some time ago for this mistreatment of physicians. Last year, during the debate on health care legislation, a New York Times editorial viciously attacked physicians because they “have been complicit in driving up health-care costs.” The editorial said that physicians are guilty of this because they “largely decide what medicine or surgical treatments are needed,” which makes many of them “unabashed profiteers.”
What President Obama calls health care “reform” will, over the next few years, make it quite clear who will decide which medicine or surgical treatments you need. It will not be your physician.
As the government becomes the exclusive authority over the cost of health care, it will inevitably become the exclusive authority over the treatments permitted in health care. Physicians or anyone else who stand in the way will become “enemies of the people.”
There are times when political rhetoric must not be ignored. There are some things that must not be allowed to just go by. Rhetoric can become government action. When a member of the Cabinet or of the White House staff threatens to keep their “boot” on anyone’s neck, when physicians are made criminals because they do not accept a government payment that does not cover their costs, “boot” is not a metaphor but the Justice Department on our necks.
Richard E. Ralston
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