dollar_signSince today was the mythological “end of the world” day, I was casting about for something positive in the news. On page after page the pickings were slim in these days of rising costs and endless Obamacare debate. I did find one possible chink in the wall on the editorial page of the Austin American Statesman (Wohlgemuth, 2012)

The author was lamenting that the 10% cut in Medicare reimbursement to providers mandated by California’s Medi-Cal program will drive more providers to stop accepting new patients. Already only 57% of California physicians accept new Medi-Cal patients and physicians are saying “if rates are cut any further, they won’t even cover the cost of treatment, and physicians will be treating Medicaid patients at a loss.”

The final point of the editorial was that Texas is facing the need to cut Medicare too, that only one third of Texas physicians now accept new Medicare patients and won’t any further cuts be awful?

Will it be awful? Might it be just what a resourceful health care entrepreneur needs?

Every Medicare patient a physician refuses to treat is money on the table and in the best of capitalism’s strengths, someone will want to pick that money up. What health care practice, or any business for that matter, cannot cut 10% of it’s overhead if the option is to go out of business? Or what entrepreneur could not come up with a new business model to take advantage of this niche market?

There are many ways to deliver appropriate and quality care at lower cost. Hire physicians assistants or nurse practitioners. Make better use of clinical diagnostic skills and do fewer tests. Minimize waste and disposable supplies. Automate accounting and billing. Make efficient use of electronic medical records to avoid duplication and unnecessary lab tests and studies. Pay staff less in terms of salary. Accept less in personal salary. Offer more aggressive, long term preventive care.

Someone said, “There is always a way someone else can do the same for less and at lower quality.” Actually, looking at other markets in our modern industrial world that quote is inaccurate. One can always do better for less.

Remember a final caveat for capitalism: There is no opportunity that will not be taken take up by someone.


Wohlgemuth, A. California Medicare ruling a cautionary tale for Texas. Austin American Statesman, 12-21-12, A11.

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