Growing up as the son of a Naval Reserves surgeon and medical school professor, I witnessed top-notch medical care, but I also saw firsthand the many obstacles that hinder doctors. One of the most frustrating obstacles is the burden of government regulations.
In rural Texas, numerous patients rely on government-run insurance programs such as Medicare and Medicaid. These programs, while used by many patients, operate under a system that forces doctors to walk a tightrope when providing care. The government mandates doctors to offer services to enrollees at lowest possible rates the doctor can afford to accept. This may sound like a protection for a low-income or elderly patient, but this actually ties the hand of a doctor from offering a discounted rate or free care to those patients. This rule was intended to prevent fraud, but has an unintended consequence: it effectively creates a ban on doctors providing free care to patients in dire straits.
Under current regulations, doctors contracted with Medicare and Medicaid face a $10,000 penalty for each instance they charge a non-government patient substantially less than the government rate. The law allows for only three exceptions: (1) care for family members or close colleagues, (2) care provided at a non-profit medical institution, or (3) care for indigent patients where financial need can be documented. Essentially, doctors cannot offer free services out of the goodness of their hearts unless they can substantiate a patient’s financial hardship with detailed documentation.
For instance, when my father is confronted with an uninsured patient, he either has to pay his staff to navigate the bureaucracy to get them enrolled in an insurance program or pay his staff to gather proof of the patient’s financial need. This bureaucratic process consumes resources and time, ironically incurring more cost than if my father could be allowed to simply provide free care. It’s a classic case of the government’s red tape getting in the way of its own mission to provide care to those who need it most.
The intention behind these regulations is understandable, though fraught with inadvertent consequences. The government wants to ensure that its funds are used appropriately and that doctors are not gaming the system. Without 42 U.S. Code 1320, doctors could potentially charge government programs such as Medicare and Medicaid, higher rates while offering significantly lower rates to private pay patients, thereby increasing their overall revenue by exploiting the difference.
This system could lead to inflated costs for government programs and misuse of public funds. However, these rules create barriers for doctors wishing to provide charity care. The hurdles become onerous if a patient lacks the necessary documentation to prove financial need. For example, how many homeless people can actually offer copies of their tax return?
Is it really prudent for the government to impose a disincentive for doctors to actually offer charity care to patients in a time where 6 out of 10 uninsured patients say they are going without needed care due to astronomical costs? My father and I say, “no.”
These government insurance regulations, as they stand, hurt their own purpose of providing care to Americans who can’t afford it. They have created an environment where doctors are disincentivized from providing pro bono care, thus leaving many of the most vulnerable without access to essential medical services. The government’s regulation punishes the compassionate and leaves the needy underserved.
Doctors, like my father, should be empowered to fulfill their Hippocratic Oath without fear of penalties. Nonetheless, there has been no move to dispose of this charity-destroying regulation. Our duty as Americans is to advocate for policy changes, such as reducing the documentation burden or increasing the exceptions under which free care can be provided. By cutting through the red tape, we can help our fellow Americans, regardless of their financial situation, to have access to the medical care that doctors want to give, making it easier, not harder, for doctors to do what they do best: care for people.