By PAUL DEMARCO
The State, South Carolina
Monday, Mar. 23, 2009
I hate to disagree with my friend John Black, the president-elect of the S.C. Medical Association; he is a good man, a good clinician and a passionate advocate for primary care physicians. But his recent column, “Medicaid: a fair price must be paid,” misses the point.
Doctors complaining about Medicaid rates in the current health-care climate are about as tone-deaf as the crew of a sinking ship complaining to the passengers about their low pay. Yes, Medicaid rates are too low and need to be addressed, but Black approaches the problem from the wrong direction. We must put patients first, not doctors.
The Medical Association must make access to decent health care for all South Carolinians its central focus. When I took the Hippocratic Oath, I took it to mean that I would care for any patient who made it to the threshold of my office, no questions asked, and that my fellow physicians would do the same. The issue of how the patient was going to pay was only a secondary concern.
I don’t deny the business aspect of medicine. Physicians endure rigorous training for years, sometimes incurring tremendous debt. When we finally begin practice, we have a right to make a good living. Most physicians realize the privilege we have in serving our patients and provide free or low-cost care to some. Black rightly points out that there is a limit to physicians’ generosity; however, his comparison of physicians and car dealers is misplaced (“the car dealer is not expected to sell for a loss”). We chose medicine over selling cars for a reason. We wanted to take care of patients, to provide them healing and compassion impossible in the car business. And we knew that would involve taking all comers.
Unfortunately, some physicians look for ways to avoid taking care of the poor and uninsured. It is a discouraging fact that part of the unraveling of the medical safety net has been physicians’ doing. Some physicians drop out of Medicaid and Medicare legitimately, but others do it to preserve a certain high salary expectation. This is an abdication of their duty to the medical profession and to their patients.
Black’s warning that the situation is grave and that physicians “can no longer pay essential bills to keep our offices open” is an overstatement. First, there is no evidence that significant numbers of physician practices are closing because of payment issues.
Second, plenty of high-paying openings are available to physicians looking for jobs in South Carolina. I found more than 100 on MDsearch.com. One listing for a family practitioner in Clinton advertised “excellent income potential in excess of $250,000.”
Third, it is not physicians who are most at risk in the current system; it is patients. Forty-six million have no coverage, and 25 million more are underinsured. According to one report, in 2001, medical expenses helped push an estimated 2 million Americans into bankruptcy.
As physicians, we must roll our sleeves up, but not in the service of padding our own pockets. We must work together to craft a system that covers all the patients that we care so deeply about. As we remake America’s health care system, we’ll ensure that its physicians are adequately compensated, but that must be a byproduct of our effort. The patient always, always, always comes first.
Dr. DeMarco is a spokesman for South Carolinians for Universal Health Care. Reach him at pvdemarco@bellsouth.net.