CMS – Proposed New Physician Fee Schedule

If you think health care is expensive now, wait until you see what it costs when it’s free
PJ O’Rourke

CMS (the federal agency that runs Medicare and Medicaid) is proposing a new physician fee schedule. The three page article that summarizes the proposed changes is hard for my ossified brain to decode, so I went to the source – the proposed rule itself. Having studied it in detail, it’s only 1472 pages long, I am relieved as I found the phrase “consumer-friendly” in it – three times at least, pages 917-19. The entire document in all its fecund glory is below. I expect all of you to study it in detail – there’ll be a test.

Medical care in the US is about $2.6 trillion. The feds pay for about half of it mostly through Medicare and Medicaid. But the rules they write carry over to the other half as well. Friedrich Hayek won the Nobel Prize in Economics for, among other things, pointing out that complex systems because of their very complexity are impossible to effectively manage. The interactions of their component parts is infinite. No one person or group of people no matter how well informed or well intentioned can understand the system sufficiently to efficiently run it. He felt it best to leave the system alone, as much as possible.

Though his reasoning seems to me, at least, self evident there are legions of bureaucrats, politicians, and voters who disagree. The result is a rule change that’s so long no one person has either read or understood it. Once enacted no one can predict how it will play out. The entire scheme (government run medical care) is so complex and unmanageable that it threatens to devour our entire economy. And a significant portion of our population wants to add to the system in the name of fairness and efficiency. Oh, what sins are offered on the altar of fairness.

Another deceased and distinguished economist, Mancur Olson, observed that the more complex the system, the more likely that it could be reformed only after it collapsed. What entities fall under the category of too big to fix? Alas, there are a lot of them. In no particular order: healthcare (its name is a joke), credit card debt, student loan debt, automobile debt, Medicare and Medicaid, Social Security, and the mother of them all the national debt. I’m just staying inside our porous borders – worldwide debt of all kinds is around $270 trillion. And we worry about floods, hurricanes, tornadoes, earthquakes, volcanoes, and plastic straws?

CMS proposed fee schedule