Children on Medicaid are denied care as many docs become hypocritical about the Hippocratic Oath

A study by a professor of emergency medicine at the University of Pennsylvania released this morning shows that children on Medicaid are denied care more and have to wait much longer for appointments than other children. 

The details of the study are stunning: Two-thirds of children whose parents mentioned they were on Medicaid were denied appointments, compared to only 11% of children whose parents did not mention Medicaid.  For those clinics that accepted both kinds of patients, callers who said their kids were Medicaid had to wait an average of 22 days longer for an appointment than those who didn’t mention receiving Medicaid.  The study covered Cook County, Illinois, an enormous metropolitan region that includes Chicago and many suburbs.

These despicable figures follow reports featured in a USA TODAY story a year ago that documented the growing number of physicians who don’t accept Medicare patients:

• The American Academy of Family Physicians reported that 13% of family physicians didn’t participate in Medicare in 2009, up from 6% five years earlier.
• The American Medical Association said 17% of all doctors and 31% of primary care physicians they surveyed limit their Medicare patients.

These physicians who turn away the poor because they won’t get paid as much money to treat them are truly hypocrites, because they all took some form of the traditional Hippocratic oath, named after a Greek physician known as the father of medicine.  Wikipedia’s version of the classic English version of the Hippocratic oath includes this paragraph:

“I will apply dietic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.”

And here’s a line from the widely used modern version: “I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.”

No one is asking these doctors who turn away Medicare and Medicaid patients to treat them for free.  We ask that they treat the elderly and the poor at a reduced fee. 

U.S. physicians earn a whole lot more money than their peers in every other country in the world.  It’s open to debate whether or not our doctors are better practitioners and therefore deserving of all money.  But consider this: comparative mortality charts suggest that doctors in many other countries achieve superior results to our physicians. 

Let’s not even argue the quality point because it doesn’t matter in the discussion of why American physicians make more than their global peers.  The American doctors live in the only advanced economy that follows the free-market healthcare model.  Their bigger bucks stem from the luck of the draw.  American physicians not only make more than their global peers, they also make more than virtually any of their patients, that is except for docs who cater to what they used to call the carriage trade.

We constrain free markets all the time, with regulations, tax policy and other market incentives and disincentives.  I’m therefore going to propose a new constraint: as a requirement of keeping the right to practice medicine the percentage of all patients that the doctor treats who are Medicare/Medicaid patients must be a minimum of 85% what it is for the Metropolitan Statistical Area where he/she has offices.  For example, if 15% of all patients in the area are on Medicare and Medicaid, then 12.75% of every physician’s patients must be enrolled in Medicare or Medicaid. Physicians going below 85% would automatically lose their medical licenses for a period of three years. 

The costs for this program would be minimal. With modern digital technology and the rapid implementation of electronic medical records in all physician offices, filing an annual report should be quite simple.  Of course, there would also have to be a small increase in the bureaucracy to audit reports and do spot investigations.  My guess is that this new regulations will lead to a decrease in Medicare/Medicaid costs over time, because adding new participants to a free market always reduces overall costs.  It’s an axiom of capitalist economics!

I would think that those thousands of ethical women and men comprising the majority of physicians would wholeheartedly support this new regulation, as it will level the playing field and take from them some of the burden of caring for patients for reduced fees.