At least you can deduct 22 cents per mile to get to work on the days you provide charity care

And for those physicians wanting to quit because of this type of law–well Ayn Rand illustrates in Atlas Shrugged that soon quitting your job will become illegal, too.

EMTALA itself is nearly 25 years old. When did you enter medical school?

So if none of you made this deal, how are you trying to distance yourselves from it?

You’re also not making the distinction between Medicare/Caid reimbursement issues, and the EMTALA mandate.

And once again, you attempt to deflect from the fact that none of us in current practice made the deal-with-the-devil that we currently have with Medicare. Last time I saw the stats, 40-45 cents of every health care dollar goes through federal hands… so unless physicians decide to strike en-masse (which would cause a lot of deaths, about which your ilk would endlessly castigate/litigate), the feds are driving the train.

And before you whip out your standard “AMA-blah-blah-blah” boilerplate, the AMA doesn’t represent me.

You should stick to what you know.

This remains incorrect. I don’t make any money on making physicians look bad, never have. The one medical malpractice case against a physician I handled involved a physician who performed a tubal without the patient’s consent, then falsified the records so that no one would know. I personally did nothing to make them look bad. The physician did that on their own.

“BS. You can’t get blood out of stone, and all of us know it.”

All well and good, but it still ain’t charity if you don’t INTEND not to collect. You have no idea WHAT the financial circumstances are of those that come in, you’re judging solely on appearances. If you choose not to pursue collection, that’s a business decision you’re making. But there are a lot of agencies out there dedicated to squeezing blood out of those very turnips. Still, that’s not charity on your part.

“The point is that we’re forced, by law, to see everyone and anyone… regardless of ability to pay. It’s forced indentured servitude, and there’s no “decoupling” to speak of, since it’s a completely unfunded mandate from the feds.”

Nonsense. You’re not “forced”. You choose to in order to get the government money. You sign a contract whereby YOU get government money, and in exchange the government says in order to get our money, you have to take all comers. No one makes you sign that contract. And no one dupes you as to its terms.

It’s not “mandatory” that you enroll in Medicare.

You’re right that Medicare was enacted before most of you got in practice, but the government pay has worked pretty well for you guys for decades. For some reason you believed that the pay would always go up, which speaks more to your naivete than anything. So now it’s time to figure out a way to wean yourself from it. You’ve known this was coming for a few years – come up with anything?

“How would you like a forced mandate of “pro-bono” work?”

Depends. How much do you make annually as a result of this contract you sign that you consider “forced”? The average ED physician makes what, $180,000 on average? I’d consider it strongly for that.

Although truthfully, your public defenders, which also take all comers, make significantly less. So there are people in my profession who are willing to take the tradeoff already.

You’re too funny. You may not NOW… but you used to. You made money on making physicians look bad, but it’s all good, because you were acting as a fiduciary, right?

If it’s self-pay, you have the right to collect, and you intend to collect when you do the service.

BS. You can’t get blood out of stone, and all of us know it. In fact, we don’t even try… for instance when they’re obviously illegal and have no documentation or address, we pretty much know that’s the end of the line. We write off plenty of debt as “uncollectable.” As for Medicaid, that’s a pittance.

The point is that we’re forced, by law, to see everyone and anyone… regardless of ability to pay. It’s forced indentured servitude, and there’s no “decoupling” to speak of, since it’s a completely unfunded mandate from the feds.

That you don’t understand the difference between that and our mandatory enrollment in Medicare (that is, if we want to work at any hospital) is actually pretty funny. It gets worse every year, and most of it was a done deal before most of us even entered practice.

How would you like a forced mandate of “pro-bono” work?

You, like many physicians, apparently don’t know the definition of pro-bono or charity. That’s work you do where you don’t intend to get paid. If it’s self-pay, you have the right to collect, and you intend to collect when you do the service. If it’s Medicaid, while you may not make as much as you want, that’s not pro-bono or charity.

I’m not lecturing you on not doing enough. I’m lecturing on constantly whining about the very forseeable results of choices you made. YOU made them. If you don’t like the results, then make a different choice. Either way, quit whining incessantly.