#provider tax

[surgerycenterofoklahoma]

Americans for Prosperity on the Provider Tax and Medicaid

Here's an embarrassing video on the provider tax scam and why expanding Medicaid is supported by the corporate medical machine and many state governments from Americans for Prosperity.

G. Keith Smith, M.D.

[surgerycenterofoklahoma]

Unwanted Provider Tax Scrutiny

Michael Carnuccio steps up to the plate and hits this one out of the park.  More great stuff from the Oklahoma Council of Public Affairs.  Well done.

G. Keith Smith, M.D.

[surgerycenterofoklahoma]

"Not for Profit" Hospitals' False Flag

Let's say that a "not show a profit" hospital happens to be paid 3 times by Medicaid what our surgery center is paid by a private insurer.  Yes, you read that right and it's actually true.  Keep this in mind as you hear politicians talk of their concern about government spending and the bankruptcy of health plans like Medicaid! Let's break this down.  

Let's say that the surgical procedure we are considering results in a payment to our surgery center of $1000 from private insurance (an actual example).  Actually, the $1000 is what the insurance company calls the "allowable" charge.  If  a patient has a $2500 deductible, it should be clear that they are paying for this particular procedure completely out of their pocket if they've not met their deductible.  If they have met their deductible they are probably still going to have to pay some percentage of the $1000, probably 20-40% out of their pocket, still a significant portion of the charge, given that they have paid $800-900/month, minimum, for this "coverage."  

Now let's look at this from the hospital angle.  Same procedure.  Medicaid pays the hospital $1500.  Then the disproportionate share hospital padding is added, in this case, another $1000.  Then, the "provider tax" (see my blog about how this works here) amount kicks in, bringing the payment to a little over $3000.  But wait a minute.  The hospital doesn't pay tax!  This "minor" concession basically doubles the value of the compensation!  

But wait.  Isn't the hospital cost-shifting to everyone with private insurance due to the "losses" they sustain on these Medicaid payments?  It's not hard to show losses if you subtract their Medicaid compensation from their outrageous hospital bills, though, is it? And the uncompensated care padding is predicated on the "not for profit" hospitals generating these fictitious "losses."   Wasn't one of the main reasons we were saddled with the Unaffordable Care Act was to guarantee payment to these "struggling" hospitals, so they wouldn't shift costs to the rest of us to cover these Medicaid "losses?" 

Now keep in mind I am comparing private insurance payment at our facility to Medicaid payment at a "not for profit" hospital.  I have done this intentionally so that you can see that the worst paying insurance (Medicaid) pays the hospitals multiples of what private insurers pay our facility for the same procedure.  

Big hospitals going broke?  Give me a break.  Little hospitals are going broke thanks to the big hospitals, that's for sure.  Hospital bills high because costs are shifted from Medicaid and other losses to those who are paying?  Give me a break.  Obamacare will lower our health costs due to its remedy of this situation?  Seriously?

G. Keith Smith, M.D.

[surgerycenterofoklahoma]

"You take the risk and I'll take the profit!"

A democrat legislator recently chided those governors not embracing Obamacare’s Medicaid expansion.  The gist of her argument was that most of the expense would be borne by the federal government anyway.  Where does this cretin think federal funds come from? 

Just as troubling to me is the general acceptance of state agencies helping private businesses garner federal funds.  We have seen this with the provider tax here in Oklahoma where private hospitals pay a 1% tax to have it returned to them 3 fold.  These outfits are hoping you won’t connect the dots between the “tax” they pay on one hand and the loot they grab from your pocket with their other hand.  

This crony corporate welfare enabled by state legislation and agencies is what I like to call “favors we can live without.”  Rex Smitherman in today’s “Daily Oklahoman” tells us the story of Cyrus Zegrati, a microbiologist who Mr. Smitherman mentors on the fine art of pick-pocketing the taxpayers.  Mr. Smitherman’s organization, i2E, is funded in part by the Oklahoma Center for the Advancement of Science and Technology (OCAST), one of whose goals is “to boost the state’s share of SBIR (Small Business Innovation Research) grants.”  

Let’s summarize.  Mr. Smitherman, CEO of a “nonprofit corporation that mentors many of the state’s technology-based startup companies,” is the recipient of your wages and mine through a state agency (OCAST), and his job is to help people like Mr. Zegrati find his way in to your wallet through NIH (National Institutes of Health) and SBIR grants. 

How is this any different from the crony capitalism so vilified on the federal level, the bailouts of the banksters, Solyndra and many others?  Isn’t this moral hazard, that situation where one is set up to profit from placing other’s money at risk?  

Entrepreneurs risk private capital for gain.  Successful ones are those able to predict future demand for services or products that help their fellow man in some way.  Those seeking and obtaining public, taxpayer money for their private gain are another type of individual altogether, rightly referred to as thieves, as they are truly the recipients of stolen property.  That they have harnessed some “acceptable” means of extracting what is in our wallets really makes no difference.  That they have an intermediary do their dirty "wet" work, still results in our being robbed of resources we might have more pressing uses for in our own households. 

Mr. Zegrati’s idea may have been appealing enough in the private sector to gain the confidence of private investors, but sadly, we will never know.  If his “company” is successful, he will actually be an example of someone “who didn’t build his company.”  Forcibly redirecting private money for public use results in mal-investment and allows bad and unprofitable schemes to proliferate, as the ruin of failure is shouldered by the taxpayers not the visionary, throwing much of accountability to the wind. 

I wish Mr. Zegrati the best.  I just wish he had pursued his dreams without money taken from the rest of us without our consent.  That our state legislature taxes us to enable this heist at the state and federal level is truly unconscionable.  

G. Keith Smith, M.D.