The Patient Protection and Affordable Care Act (aka Obamacare) began with the back-room deal-making, last-minute arm-twisting, the unprecedented distortion of congressional procedure and the final vote of 219 to 212 in the House - a relatively narrow
margin considering the total Democratic control of Congress at that time. Obamacare survived a Supreme Court challenge by an even narrower 5-to-4 vote, on the basis that the individual mandate is a tax, despite the president's insistence that it is not a tax.
I wonder if any legislator actually read the entire 2,700-page monstrosity before passing the law. Buried within it is the requirement that all doctors enrolled in Medicare must re-enroll. One of the conditions of re-enrollment has chilling Orwellian overtones - the government must have direct access to the medical practice's bank account. I pleaded with Medicare for an exemption. Since the clinic was "nonparticipating" with Medicare, we received no payments from the government but instead collected from patients, using the discounted Medicare fee schedule. Medicare then would reimburse patients. Since the clinic did not deal directly with the government, why should the government have access to its account? I was told there would be no exceptions.
Further complicating the situation is the facts that the clinic sees a lot of visitors and that some people over 65 continue to work and have commercial insurance in addition to Medicare. It would be so simple if, in cases of dual insurance, the commercial insurance comes first. But it depends on the size of the patient's company. If the employer has more than a certain number of employees (40, I believe), then commercial insurance comes first. Below that number, Medicare comes first.
Too often, a problem arises when a patient mistakenly tells us that the commercial insurance is primary and is given the insurance claim form to send to his or her insurance. The insurance company, not being the primary carrier, then forwards the claim to Medicare for processing. This automatically generates a letter from Medicare threatening the clinic with a $2,000 fine since regulations - Section 1848(g)(4) - dictate that the claim must be sent directly to Medicare by the clinic.
I have always ignored those threats because in order to collect the government will have to take me to court and I will prevail since it is not my fault that the clinic was provided with the wrong information. But can you imagine if the government had direct access to my account? $2,000 would be taken out each time an inadvertent mistake is made. I will not be able to pay the clinic's rent or meet my payroll. I may have to close the clinic and lay off all my employees.
I refused to re-enroll. In January, I received a letter saying that my Medicare billing privileges had been deactivated. This meant that Medicare patients no longer would be reimbursed. Consequently, I have referred all Medicare patients to the Maui Medical Group, which owns its facilities and is large enough to afford to participate in Medicare. Broken is Barack Obama's campaign promise of four years ago that you can keep your doctor.
Politicians and bureaucrats have managed to subdue and subjugate what was once a respected and noble profession. The threat of fines and sanctions for any infraction of the myriad government regulations has essentially criminalized the practice of medicine. In the depersonalized jargon of the bureaucrats, a physician is not a doctor but just a provider; a patient is not a patient but a covered life. The sacred doctor-patient relationship is split asunder when the government wedges itself between the doctor and the patient. The danger here is if the physician places the interests of the government before the interests of the patient. With Obamacare, the government's desire to be in control pre-empts the individual patient's right to choose between various treatment options.
* Ben K. Azman, M.D., is the founder and medical director of the West Maui Healthcare Center in Kaanapali.