Free equals fraud

I wish I could applaud the Massachussetts initiative to require everyone to have health insurance. I haven't seen much to recommend the government as a responsible regulator of insurance or healthcare. Healthcare too easily becomes an entitlement that can be used in the way that circuses and bread were in old Rome: If you play along or they want your vote, you get State-issued bread and a general seating ticket to the circus. If you can be marginalized or demonized, you will be sacrificial fodder for the lions. The coordinated Medicare crowd will always want to be treated seperately from the rest of the insured, and it will always be useful to blame the greedy doctors for high costs, while ignoring the $125 Million yearly salary of insurance Execs.

Here's part of an op-ed on healthcare by Donald Devine, from the Washington Times. There is one possible mistake: if the doctor does not charge for a visit at all, then he is more than like safe. However, there is dispute about that belief and it's never been tested. Most advisors tell us to forget about professional courtesy, for example, since it might look like "fraudandabuse."

"God help us if we inadvertently write off charges or perform services that Medicare doesn't see medically necessary and bill the patient without an advance beneficiary notice (ABN) signed. The average citizen does not understand basic health insurance let alone all the rules and regulations surrounding it. So for them it is hard to understand why we cannot just write off their balance. They think physicians are money hungry. There are so many rules and regulations that are constantly changing there is really no way to keep up. Once you think you have it down something somewhere changes or is in the process of changing. I fear government in these instances. If I were to ever be audited and missed something my physicians would be at risk of huge fines and even jail. I then would be out of a job no questions asked. I do not believe that we have much control over our government as we are sometimes led to believe."
When one reads about doctors being hauled off to jail for fraud, odds are this is the cause: guilty not of fraud but of charity. If a health provider bills for either government program, it is subject to a federal audit. Every patient's record, whether Medicaid or Medicare or not, is scrutinized to assure that no non-government patient pays less than the government. A physician can fill out paperwork for an exception but who will take the time or the risk? If the health provider gives anyone an undocumented break this is "fraud" and it is off to jail for the foolish Mother Theresa.
The decline in charity by physicians documented in the study is guaranteed to get worse. It shows that most charity is performed by doctors working in small practices. Large practices already hire people like the student to assure they commit no charity. As the smaller practices become aware of how the government operates, they will perform fewer charitable acts.
The unique American attribute of private and local charity that has so amazed the world since the French observer Alexis de Tocqueville described it so vividly in the early 19th century will soon be regulated away, leaving a world for our children and grandchildren where it will be impossible to give free medical assistance for fear of being accused of fraud.