Friday, July 13, 2012

Government Regulations and My Medical Clinic

     The Bill of Rights placed enormous limitations on our government's ability to interfere in business and professional enterprises.  Our Founding Fathers had firsthand experience of a government--England--that had become dictatorial and rapacious.  Therefore they wanted to ensure that the American people would never fall victim to a greedy, top-heavy, spendthrift, self-serving government again.  Their efforts have failed:  the United States government is more powerful than England ever was, thanks to thousands of constitutional amendments and statutes which have been passed, ostensibly, to "care for" and "protect" Americans.
     The twentieth century gave our government so many liberties, hurriedly swiped while Americans were looking the other way during imagined and real catastrophes, that the United States federal government is now involved in almost every aspect of American life and business.  Government regulation is expensive to enforce, so it's adding to our walloping national debt.  More portentously, federal intrusiveness is costing all of us our freedom.
     As an American physician I have been hampered most by the government's interference in the practice of medicine, telling us what to do, how to do it, and what will happen if we don't follow the constantly changing mandates from above.  These mandates include such things as:  when and how to give immunizations;  how to treat patients with diabetes;  what foods to recommend;  what vital signs must be recorded;  how many bullet-points of documentation must be in the chart for each dollar billed to Medicare;  how cold the temperature of our refrigerators must be;  how often the incubator must be checked, or the spirometer calibrated, or the x-ray machine inspected;  how legible my signature should be;  who gets to look at patient charts;  where we're allowed to store supplies;  how to clean blood droplets from the floor;  what labs we're allowed to do;  what prescriptions we can write;  how long we have to store records;  when to report abuse, and to whom;  whether and how people should be allowed to die;  and how many volumes of procedures and protections we must compose, label,  update and keep on our shelves.
     This degree of regulation is bad because the government (which doesn't have a medical degree) is forcing doctors (who do have degrees, and understand their patients) to do things that don't make sense.  What's even worse is that special interest lobbyists manipulate congressional representatives into passing legislation that forces doctors and businesses to do things that profit those same special interest groups, not patients, not citizens, not small businesses, not the nation.
     Here's an example.  All physicians must start using electronic medical software by next year or we will be fined, via steep pay cuts, by the government. But I know very few physicians, especially in solo practice, who think electronic records will improve efficiency or patient care.  The initial cost to clinics is between $20,000 and $200,000, and the ultimate cost--including transition and software maintenance expenses--is much higher.
      If physicians want electronic software they're free to buy it.  So who benefits from a government fiat forcing us to implement this complicated junk?  The electronic software manufacturers, of course.  They persuaded the government to mandate use of electronic records by Medicare physicians, and their profits will be in the billions.  It's obvious that lobbying is a lot easier--and more lucrative--than running a clinic.  Our legislators must be a bunch of gumbies, to have passed this law.
     Gumbies?  Wait, I forgot:  the legislators will get re-elected because they passed this law.  They're not gumbies, they've got the whole snookering stratagem figured out.  They know they're not elected by citizens, but by big businesses that make "donations" to their campaigns--donations they can easily afford because they're selling so many government-mandated products.  The mucky money comes right back to them in the next round of legislation, when the government helps them again.  What a neat system!
     What happened to free enterprise?  If the product is really good, we'll buy it.  If it's junk, we won't, and the companies who make it will go out of business.  I thought that was a great system:  sink or swim.  Why is the government ministering to the makers of junk?
     (Could this "junk" give them even greater access to the world of doctors, so that catching clinics in the inevitable act of miscoding claims [fraud!] will yield revenues, in terms of take-backs and fines, for our faltering economy?  But I don't want to be mistrustful...)
     As an American business owner I have been hampered most by government intercession as I run my office from day to day.  There are dozens of inspectors and regulators, most requiring fees and detailed forms, and it takes a great deal of time away from patient care to produce all the data they want.  (Has anyone but the inspectors ever opened the hefty OSHA, HIPAA, CLIA, VCF or AHCA manuals in a medical clinic?)  Filling in the boxes on their redundant certification forms is an exercise in frustration.  Copying medical records for Medicare all day (especially since the FBI alerted Medicare to withhold payments owed to me) and employing office staff to keep up with the requirements of bureaucratic zeal is a waste of talent.  
      American medicine must be one of the most heavily regulated businesses in the world.  Why?  It must be profitable to someone.  Turns out, at least in my case, it's profitable to the government.  They're probably expecting to keep all the money they took from my bank accounts whether there's a reason or not.  That's the prerogative of power.
     There are so many thousands of pages of imperatives and rules for physicians (the Medicare web-based "Guidelines" alone are over 20,000 pages) that every doctor in the country must be breaking some of them.  Therefore we're easy targets when the government wants to "take action."  
     And the government is out of cash.  It owes a ton of money.  Send in the FBI!  It's not stealing if there are statutes legalizing raids and forfeitures on private businesses.  It's not likely to be questioned if the affidavits granting these seizures are allowed to be sealed practically forever.  And doctors?  They're not likely to speak out if they're feeling terrified, confused and ashamed.
     A government that regulates everything its citizens do is totalitarian.  A government that punishes those who resist is inflexible.  A government that has easy license to raid and steal from working people like me, without cause, is corrupt and despicable.  
     Is this the America we want?

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