Sunday, November 10, 2013

Action Needed: California Doctors Who Refuse Medicare or Medi-Cal

There is a simple and fair solution to the increasingly common problem of California doctors refusing to accept Medicare and Medi-Cal patients.

What point is there to giving seniors, the disabled and the insolvent Medicare and Medi-Cal if many doctors refuse to accept them as payment?

What kind of person refuses to accept Medicare and Medi-Cal? An anti-social person. A person who entered the medical profession driven by greed, not by the desire to help people. A person who does not even care about other doctors, whose own incomes are hurt when they have to take too high of a ratio of Medicare patients to make up for sociopath doctor behavior. In short, a criminal, but a white collar criminal who can do far more harm to people through negligence than an ordinary street criminal can do through theft.

Before going further, let me say that, on the whole, Medicare and Medi-Cal pay scales are fair. When a doctor or hospital says they are losing money when they accept Medicare or Medi-Cal, in truth they are saying they cannot ream these patients, and the taxpayers, the way the ream private insurance companies and the poor saps who come in without any bargaining power over the price of services. Medicare payments are enough to cover costs and provide an upper middle-class standard of living for doctors and fair wages to other health workers. If some payments for some services need to be raise a bit to be fair, I have no problem supporting that.

What happens when a doctor refuses Medicare patients? A senior will likely end up on a long waiting list, their health deteriorating while they wait. In some cases there may be no similarly qualified specialist in their area. Turning away a sick person because Medicare will pay for their treatment is a form of malpractice.

The solution is obvious. Any doctor who refuses Medicare/Medi-Cal patients should lose their license and pay a hefty fine. There should be a regular system to check for these abusers of our system.

In writing legislation to include good social behavior as a licensing requirement, there does need to be care taken to be fair. For instance, the Medicare load differs by location and specialty. It would not work to set a specific percentage of Medicare patients all doctor must see in order to keep their licenses. An individual doctor might reject a new patient because they are truly already fully booked, perhaps even mostly with Medicare patients.

The current Medicare bureaucracy should be sufficient to monitor physician compliance and take into account variations in locality and specialty. Some parts of America have a high percentage of seniors, others low percentages. That should not be hard to take into account with a formula that would flag potential bad eggs. Area doctors can be surveyed. If, of ten in the same specialty, nine complains that 70% to 90% of patients are on Medicare or Medi-Cal, while the tenth is near 0%, it should be clear what is going on.

Of course the first thing the bad doctors will do is stop saying why they are refusing patients. They might also try seeing patients, charging Medicare, but not actually treating patients, something that already happens all too much.

We all (or almost all) pay into Medicare throughout our working lives. To be denied care in our old age by a doctor is a crime. We should be able to call an authority to report such criminal behavior, and they should be happy to end up with only a suspended license, not behind bars with the other criminals, where they really belong.

It is difficult to get a slot in medical school, and so the number of doctors is limited. With a license to practice comes the responsibility to practice fairly, including taking a fair load of Medicare and Medi-Cal patients.

Friday, April 19, 2013

Demand California's Fair Representation in the U.S. Senate

How do you feel about the allegedly democratic government of (not its real name) Syriastan?

To keep control of the Syriastan its ruling class has created electoral districts that each get two votes in its parliament, but have vastly different populations. One district in particular is discriminated against. It gets the same two votes as the others, but it takes 22 other districts to attain its population.

This goes against the basic democratic ideal of one citizen, one vote (one man, one vote in traditional patriarchal speak).

If the people of that oppressed district rebelled, demanding equal representation, would you support them? Of course you would. Why, such nations are Un-American!

Sadly, Syriastan is the United States. As the following table and graph show, it takes the population of the 22 smallest states to overtop the population of California. Those states get a combined 44 votes, enough to prevent any legislation they don't like from getting through the U.S. Senate (because of rules requiring a supermajority to pass a law).

California's estimated 2012 population: 38,000,000.

Our equivalents in population:

State  Population
Wyoming 576,000
Vermont 626,000
North Dakota 834,000
Alaska 732,000
South Dakota 834,000
Delaware 917,000
Montana 1,005,000
Rhode Island 1,050,000
New Hampshire 1,320,000
Maine 1,330,000
Hawaii 1,392,000
Idaho 1,596,000
West Virginia 1,855,000
Nebraska 1,856,000
New Mexico 2,086,000
Nevada 2,759,000
Utah 2,855,000
Kansas 2,886,000
Arkansas 2,950,000
Mississippi 2,985,000
Iowa 3,074,000
Connecticut 3,590,000
total: 39,108,000
California vs. small state represenation in U.S. Senate

This major flaw in our system goes back to the original compromises made to get the U.S. Constitution in place in 1789. At the time the decision was made to give each state two representatives in the federal Senate, the total population of the U.S. was less than four million. The least populous state was Delaware with 59,000 people, the most populous state was Virginia with 747,000 people (including 292,000 slaves).

In 1789 the population ratio between the least populous and most populous states was approximately 1 to 13. Today the ratio between Wyoming and California is 1 to 66.

It was an undemocratic decision at the time, basically the result of political blackmail by the small-population states, whose elites feared federal control.

It has gone on too long. Demand reform.

Every U.S. citizen should be represented fairly in the U.S. Senate.