When the Government Is in the Exam Room, It's Bad for Doctor and Patient

While listening to a clip of doctor representatives of the American Association of Physicians and Surgeons, I wasn't surprised to hear that internal polling of their members revealed that 65 percent of doctors would prefer to treat Medicare and Medicaid patients for free than deal with the government. That's certainly my perspective.

In fact, in my own office, Medicare and Medicaid are not accepted, but we do affiliate with the free clinics around the county, as do many, many other doctors. Helping people heal is why most doctors go into the business. That the business is also intellectually stimulating and personally rewarding is often secondary.

Why would the majority of doctors prefer not to deal with the government's health care system?

1. The ever-changing bureaucratic rules make for compliance challenges. Codes change. Coverage changes. And doctors have to keep up with this arcana in order to comply with the federal government. Imagine having to deal with the IRS about every investment you make, every purchase for your business. That's what it's like when deciding the best course of health care for a Medicare patient.

2. A doctor gets paid dirt for his trouble. Not only do doctors have to juggle like an acrobat at the circus when dealing with the government, they get paid cut rates to do so. At a certain point, the administrative costs outweigh the benefits of the hassle. Doctors just won't do the procedure or just won't work with the government-run health care system.

3. Patients covered by Medicare have a different attitude towards their health care. The further removed a patient is from paying for his service, the more entitled he feels and the less motivated he is to change his behavior. When a patient is unmotivated to take ownership of his health care choices, it can make doctoring extraordinarily frustrating.

Doctoring can be a soul-satisfying blend of human connection, scientific inquiry, and technical mastery. The doctor is motivated by solving the mystery, delivering excellence, and helping the patient feel better.

A dentist friend of mine specializes in root canals. He is the best at it anywhere, he bragged. You will feel no pain whatsoever and can get back to work today, he assured. He was right. He loves doing root canals and he's very good at it. It is very satisfying, challenging work. Another friend is an orthopedic surgeon and he got dreamy-eyed talking about how much he loves doing knee surgeries. Not only does this man get to do complex procedures, he gets to help people live better, longer, and more productive lives. A plastic surgeon friend admitted that he loved doing breast reconstructions, especially for women who've had breast cancer. He likes helping them look beautiful and feel good about themselves. All of them do pro bono work for people who can't afford it.