My experience with government medicine goes back to 1965 when Medicare and Medicaid began. Johnson took the advice of Bevan who, when the NHS began, “filled their mouths with gold” to get specialists on board. That meant generous terms early on. Of course, as the years went by, those pay scales stayed the same. In the early years of Medicare, reimbursement rates were good.

Medicaid, the program for the poor, was never as generous. In fact, right from the start, Medicaid (MediCal in California) paid slowly and poorly so the program was quickly taken over by “mills” that would make money by running large numbers of poor patients through the system, billing for every known test. As this became obvious, Medicaid responded, not by boosting reimbursement to attract more mainstream doctors, but by progressively more and more onerous rules and lengthy delays in payment.

I even knew doctors who quit residency programs to open Medicaid mills in the late 1960s. The chance to make money was too good and they passed up more training. When I began in practice in 1972, having finished six years of postgraduate training, I signed up for MediCal as a sort of patriotic gesture even though I was in middle class Orange County. MY office was quickly filled with women wanting varicose vein injections. I was the only one doing them for years in OC. Soon I found that MediCal paid about six dollars after about 18 months for the procedure. My office staff pleaded for me to quit the program and I obliged. After that, I saw MediCal patients only on the request of other docs, many of whom also cared for them but never listed themselves as participants. Of course, we also got a lot of them from ER call

Now, I suspect, there will be less concern about sweetening the pot as the feds will have the only game in town. That is why the private option is so important. They could do a good job with a single payer program but I don’t see why this should be the only thing that Obama does competently.

David Petranos Esq. And MKDP – Pay no nevermind to people like Dana. They just have not had the pleasure of sufficient exposure to your brilliance in order to appreciate it. I, on the other hand, am a devoted fan. Please come back. I beg you.

I’m always a bit confused when this commenter appears – I’m not sure what to say, or do, or what it is he wants. I hope someone does. But wow, what a nifty drama-filled handle. It makes Esq. seem rather pedestrian.

I’m sensing a pattern forming