Kevin,MD links to one of the most trenchant indictments of government-run health care I have read. Bureaucratic stupidity and price controls forced Dr. Linda Halderman to close a practice whose patients were mostly uninsured and underinsured: 

I was forced to stop providing services as the only breast cancer surgery specialist in a 70-mile radius in central California who still accepted Medi-Cal. I could no longer afford the $10,000-$15,000 monthly hemorrhage related to reimbursement so low it would be cheaper to close my office doors.

This is happening in rural areas all across the country. Government health care programs are creating shortages of doctors and hospitals in the very areas where they are needed most. And who loses? 

My own loss is nothing compared with what the women who will be diagnosed with breast cancer in my community will face. “Coverage? with a government-funded “insurance plan? for them offers no coverage, after all. 

In other words, “free? government health coverage is utterly meaningless to these patients because it is systematically undermining the viability of the providers from whom they must receive actual medical care. All of which has caused Dr. Halderman to cast a jaundiced eye on the “reform? proposals offered by various politicians: 

Forgive me if I am a bit skeptical at the reform proposals made by California’s Republican Governor and at least three Democratic Presidential candidates, all of which include a greater role for government in funding and directing medical care for lower-income populations.

The voters should be equally skeptical.

Comments 12

  1. drmatt wrote:

    Strangely, her suggestion in the article is to take medicaide money and buy low priced insurance, which is the crux of the plan of the politicians which she later criticizes. Cant have it both ways. Furthermore I would add that government health care is one of many factors that are causing decline in doctors, and available services; rising health insurance costs leading to less people with insurance (thus an increase in people on the dole), rising cost of liabiltiy insurance (I paid 22,ooo.oo in my last year), more complicated and decreased reimbursement by the commercial health insurance companies, increased overhead caused by commercial health insurance’s obtuse and totally chaotic billing rules and practices, and the debt burden associated with medical school among others. Point being, there will be no fix to our ailing health care system from the government or the private sector unless we discuss and change all the negatively effecting factors. If free government health insurance is utterly meaningless, what is no insurance?

    Posted 31 Oct 2007 at 6:16 am
  2. Matt wrote:

    Similarly oddly, for all his persistent criticisms, one of the foundations of Catron’s remedy is simply to put more money into Medicare to pay doctors more. Along with nationalizing insurance.

    There is no shortage of criticisms, however there is a shortage of detailed solutions.

    Posted 31 Oct 2007 at 10:44 am
  3. Marc Brown wrote:

    ‘Point being, there will be no fix to our ailing health care system from the government or the private sector unless we discuss and change all the negatively effecting factors.’

    Nothing will change until you introduce decent national or state insurance systems and commission services to meet local need.

    Posted 31 Oct 2007 at 11:07 am
  4. drmatt wrote:

    I personally agree with you Marc, I also think that a national health plan will have the bargaining power (without the loyalty to stolk holders) to place much needed restraints on the pharmacuetical industry and the medical liabilty thieves. Furthermore a system designed to outline, evaluate, and use/pay for (proportionally) medical techniques, tests, treatments and interventions that are actually proven to benifit while causing minimal harm would benefit all of us. The corporate insurance companies (by law) have a primary responsibility to stolk holders, not policy holders.

    Posted 31 Oct 2007 at 12:58 pm
  5. drmatt wrote:

    In regards to the title “The Tragedy of Gvovernment-Run Health Care”. Terribly inaccurate, the health care in this tragedy is not run by the government, it was run by the doctor, who chose to accept a govt insurance plan. She closed her practice for the same reason I closed mine, she moved into a community where the proportion of people on sub standard insurance was greater than those on reasonable insurance. With good conscious and integrity she accepted the members of her community, unfortunately the math was against her. If you are under the impression that the government insurances are the only ones that will put you out of business you are sadly mistaken. In my community I accepted 23 different types of health insurance, out of those, three were government run (govt run insurance, not health care) and there were four that paid a reasonable reimbursement rate. The remaining 16 paid as poorly and in many cases worse than the “govt plans” and often had more beaurcracy and overall inefficiency.

    Posted 31 Oct 2007 at 1:35 pm
  6. Scott wrote:

    I would agree with most comments here. Private practices are getting hit quite hard (especially PCP’s) from both sides of the fence in terms of reimbursement. As this study shows:

    Quote: “According to our sixth annual national survey of fee schedules, average physician reimbursement from commercial payers and Medicare collapsed in 2006, with payment levels averaging 17 percent below that of 2002 and a staggering 36 percent below that of 2004.”

    With that being said; at one point in my life I was consulting a physician that was losing an awful amount of money in his practice. Well it didn’t take me long to figure out that his top five payers (by encounter) reimbursement was dreadful; the allowable’s were way below Medicare. After contacting these payers / networks, I come to find out; due to some obtuse contractual language the doctor was getting reimbursed from the fee schedule available at the time of the contract agreement. These fee schedules were not updated unless the doctor requested a review (which never happens). In other words, these fee schedules were not being updated to reflect fair market value as the years went by. No real recourse there but to cancel the contracts and start over; you have to be aware at all times in this business or prepare for a bumpy ride.

    Posted 31 Oct 2007 at 4:14 pm
  7. racquetballer101 wrote:

    Why do “we” look to the government to solve our health care issues/problems when they government has proven they can’t run a government program like a business to begin with?! I.E. U.S. Postal Service, Social Security, Medicare, Veterans Administration. Has anyone looked at Dr. Tom Coburn’s (U.S. Senator) proposed solution to the health care problem?

    I would be intersted in anyone’s opinion about his solution. Thanks.

    Posted 31 Oct 2007 at 6:27 pm
  8. spike wrote:

    Not to mention that even the most efficient payers will drive up your administrative costs when you have 23 plans that all interpret HIPAA and other regulations slightly differently. the Free market and the proliferation of payers that comes with it is a huge drain on provider groups.

    Posted 31 Oct 2007 at 7:25 pm
  9. drmatt wrote:

    Racquetballer, Coburn’s plan is pretty much terrible, first he is giving 2k to purchase health insurance? the avg price for a decent plan in this state is about 5K a year for one person and 12k for a family, not taxing income that is used to pay for health insurance only makes a difference if you change tax brackets by buying health insurance. Furthermore his implication that the insurance companies will then “compete” for patients, oh yes, they will compete for healthy patients, the rest of you, with any sign of risk will find yourself constantly shopping for health insurance, choice will not increase, it will decrease. Finally, his implication that you have no choice is also bull, only those on medicare have limited choices, you can see any doc you want, there are no laws forcing you to go to anyone in particular, you just have to decide whether it is worth paying out of pocket for, the lack of choice has been put on us by the very insurance companies he seems to want to subsidize with tax credits, they place financial barriers between you and medical care to decrease thier expenditures. Good luck with that plan, certainly isnt even close to a plan that would inspire me back to clinical medicine!!

    Posted 01 Nov 2007 at 6:38 am
  10. Marc Brown wrote:

    ‘Furthermore a system designed to outline, evaluate, and use/pay for (proportionally) medical techniques, tests, treatments and interventions that are actually proven to benifit while causing minimal harm would benefit all of us.’

    We have such a system in the UK, run by the National Institute for Health and Clinical Excellence (

    Catron likes to trash the NHS, but it has:

    - Local primary care purchasing of acute and other services (eg physiotherapy)
    - Funding by national insurance and direct taxation via both employees and employers
    - A major new hospital programme
    - Universal access
    - Improving access times – now 48 hours max to see a primary physician, two weeks max to be referred to a cancer specialist.
    - Integrated targets with social care providers.

    Yes, there are problems in areas such as dentistry. And we share issues with you such as MSRA. But no one here would swap it for your ‘system’.

    Posted 01 Nov 2007 at 7:28 am
  11. drmatt wrote:

    I actually worked in the NHS for six months or so, I understand, Catron trashes anything he doesnt understand. “Sarcasm is the protest of the weak”. There is no such thing as a system without problems, no perfect system. The question, to me, is one to be put to the population, “what do you want from the health care system?” we can’t have it all, nobody can, but we must first answer that question before we can begin to outline a system that suits us. All this banter, though interesting and educational, is pointless if we (as a society) have not come to some agreement on what we want from the system.

    Posted 01 Nov 2007 at 8:53 am
  12. Marc Brown wrote:

    Indeed. Thanks to David – he’s drawn attention to the latest Commonwealth Fund study:

    ‘A new Commonwealth Fund survey finds that, compared with adults in six other countries, U.S. adults are most likely to go without health care because of the cost and more likely to say that the health care system needs to be rebuilt completely. In addition to cost concerns, the survey analysis, by Fund Senior Vice President Cathy Schoen and colleagues, finds the U.S. has multiple symptoms of less-efficient care.’

    More at

    Posted 01 Nov 2007 at 2:54 pm

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