G. Keith Smith, M.D.

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This is the transcript from my latest video blog. To view it, visit my new blog page at SurgeryCenterOK.com.

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Hello. Dr. Keith Smith with you – Surgery Center of Oklahoma. Thank you for joining us in this video blog series. 

 Here’s scam #2: ‘pay-for-performance.’ First, let’s cover ‘pay for no performance.’ That would be what HMOs or ACOs (Accountable Care Organizations) do. As we’ve discussed before, pay for no performance, or ACOs, they basically make money to the extent that care is denied or delayed. So all of the people who are ostensibly taking care of you make more money to the extent that you do not receive care, or the care you do receive is very delayed. That is, where people are actually paid to not perform. 

Even creepier – and this is so counter-intuitive – is the concept and the scam ‘pay for performance.’ That sounds great on the surface, doesn’t it? We’re going to pay the surgeon, for instance, better if his patients do better. Well, the other side of that is, we’re not going to pay him as much if his patients don’t do well. That all makes sense, doesn’t it? …Until you put yourself in the surgeon’s shoes. Who realizes, for instance, that he is going to be profiled to the extent that his patients either do well or don’t do well. This will create a barrier for the sickest patients – the ones who actually need the care the most. 

This is a rationing tool plain and simple. It’s particularly awful and it’s a scam because as the physicians begin showing reluctance to see these sick patients, knowing that they’re going to be profiled, the actual amount of money that Medicare bureaucrats actually can claim they’re saving goes up. So you have this celebration in Washington D.C. and the Medicare bureaucrats are saying ‘isn’t this wonderful? Look at how much money this has saved us!’ When really, out in the trenches, the patients who really need the care the most aren’t getting it. 

Keep in mind that when someone says ‘pay for performance,’ this is really just a scam. This is a rationing tool. If someone says ‘accountable care organization,’ think: ‘pay for no performance.’ 

These are kind of two scams in one, but they basically work on the same principle. 

We’ll have more for you in this series of video blogs on the scams of healthcare. Thank you for joining us. We’ll see you next time

This is the transcript from my latest video blog. To view it, visit my new blog page at SurgeryCenterOK.com.

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Hello, Dr. Keith Smith with you, Surgery Center of Oklahoma. Thank you for joining me in this video blog series. Here’s scam #1, as promised. 

Let’s start with electronic medical records. You know, the state has such great ideas, they have to be mandatory. And this is no different. Electronic medical records actually have a place. A very limited place. 

 But the people who make these systems couldn’t make nearly the profits and money that they have made without the government mandating their use. That is exactly what happened. Votes and influence were auctioned off in Washington D.C. to see to it that these systems were mandated. 

The government also wants all of your medical records. And that is very clear from the way that they have implemented what’s called ‘meaningful use’ where patient’s medical data is basically turned over to the bureaucrats in Washington. 

None of this information in your medical record is nearly as secure once it’s digitalized because we read all the time about laptops full of patient information or big insurance carriers leaking information that’s confidential. Those stories are in the paper all the time. 

Hospitals like electronic medical records systems for another reason. Big hospitals like it because these systems have become so expensive that the physicians who have thrown up their hands and decided they can’t afford them are much more likely to succumb to an offer that they can’t refuse – to become a hospital employee. This has driven a lot of physicians to hospital employment where they can be more easily controlled by the hospitals. 

These electronic medical records systems were all about our safety so that all of your electronic medical records can be available to the ambulance or to the emergency room when you’re unconscious. It turns out none these systems communicate with each other, so none of that is true. All of these vendors consider their software proprietary so they do not work well with one another and in all likelihood, your information will not be known when you show up in the emergency room. 

There are private vendors that will actually put your electronic medical records on a zip drive that you can carry with you on a necklace, for instance, so none of these systems really provide us any safety as promised. I remember Albert Camus’ famous quote: “The welfare of the masses is always the alibi of tyrants.” That’s what I think of when I think of these electronic medical records systems. As a physician, if you use these systems in a hospital, you’ve seen these huge records in which most of the pertinent information pertaining to a patient who is hospitalized is actually very difficult, if not impossible, to find. And I think that means these records are actually not as safe as the old fashioned paper ones. 

Electronic medical records is a scam. It is nothing that we use here at the Surgery Center of Oklahoma, and I think if you ask the vast majority of physicians, they would tell you they wish they did not have to use them. 

We will continue with this series and we’ll have another scam for you here very shortly. Thanks for watching. We’ll see you next time.

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Reminder to my Tumblr followers: I’ll be transitioning my blog to my website,SurgeryCenterOK.com. New blogs will continue appear here for the next few weeks. Please bookmark my new blog to follow the conversation!

This is the transcript from my latest video blog. To view it, visit my new blog page at SurgeryCenterOK.com.

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Hello. I’m Dr. Keith Smith with you from the Surgery Center of Oklahoma. Thank you for joining us in this video blog series.

While I think it’s important for everyone to understand the good news of the application of free market principles to healthcare and how that brings us lower prices and better quality, I think it’s also important that we review the various scams and go over some of the ideas that simply are the product of a decades-long propaganda campaign by the folks who benefit from the confusing way healthcare is billed.

We’re going to talk about giant hospital bills. We’re going to talk about repricing. We’re going to talk about insurance-negotiated discounts, and the spiraling cost of healthcare, and the not-for-profit accounting fiction of some of these hospitals.

We’re going to go over some of these scams one at a time. And we’ll do those in a series of blogs coming up that I encourage you to refer back to so you can understand it.

I think it’s important to keep in mind that the really good news is that the free market has been shown by countless individuals now all over the country to apply to the industry of healthcare. But it’s also important – however disgusting it might be – to understand the scams so that you will know the lies and the propaganda when you see them.

Stay tuned for a breakdown of these scams. We’ll review them one at a time. I know some of this is repetitive, but it’s very complicated. And it’s complicated for a reason because you’re not supposed to understand what really is behind the veil. I’m gong to go over these one at a time and we’ll begin that process very soon.

Thank you for joining us in this video blog series, we’ll see you next time.

This is the transcript from my latest video blog. To view it, visit my new blog page at SurgeryCenterOK.com.

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Hello. Dr. Keith smith with you again, coming to you from the Surgery Center of Oklahoma. Thank you for joining us in this video blog series.

There are lots of exciting things happening here at the Surgery Center and here in the state of Oklahoma and I’d like to pass one of the most exciting yet that has happened and give credit to those who, behind the scenes, have done so much to make this latest development come true.

First, I’d like to note that for 6 years now, we’ve had our prices online and we’ve had arrangements with individuals, with companies, with self-funded plans and we’ve saved people a lot of money over this period of time. It seemed that we got the most traction, though, in terms of the attention we were gaining, when we actually made a contract with a public entity – the County of Oklahoma County.

You know, when the taxpayers save money, that’s really a big deal. If a private business saves money, that’s not really as newsworthy. Well, the word got out that we had saved the county – Oklahoma County’s health plan, which is self-funded, a little over a million dollars in a very short, 9-month period. And people started looking at this at the state level. The Oklahoma Council of Public Affairs (OCPAthink.org) is an organization, whether you live in Oklahoma or not, I would encourage you to check out, and I would encourage you to seriously consider donating to their cause.

These are people that are in the trenches, that are liberty lovers, and they’re trying to deal with policy issues that will leave us more free. The vast majority of the time, this won’t surprise you – this involves getting rid of legislation that has prohibited us from being free.

The exciting development I want to talk to you about is just such a thing. There was legislation that was attached to the State of Oklahoma state employees health plan that prevented them from dealing with outfits like mine – the Surgery Center of Oklahoma – directly. From going to get direct pricing and contracts.

The OCPA was successful in removing these eliminations with legislation. This was a huge undertaking and they deserve all the credit for this move. It is expected to potentially save the state of Oklahoma 95 million dollars.

One of reasons that I’m bringing this to your attention is that all eyes have been on this effort by OCPA. Many people wrongly have associated this effort with me, or with the Surgery Center of Oklahoma. But it really is Michael Carnuccio, Brandon Dutcher, my friend Jonathan Small and all the staff at OCPA that have been behind this effort.

It is not likely that surrounding states or other states, when they see the millions and tens of millions of dollars of savings that result, that they will be able to resist making a similar move. Congratulations to our friends at the OCPA. I would encourage you to check out their website, OCPAthink.org, and consider donating to their liberty-loving cause.

Thank you for joining us. We’ll see you next time.

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Reminder to my Tumblr followers: I’ll be transitioning my blog to my website, SurgeryCenterOK.com. New blogs will continue appear here for the next few weeks. Please bookmark my new blog to follow the conversation!

This is the transcript from my latest video blog. To view it, visit my new blog page at SurgeryCenterOK.com.

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Hello, Dr. Keith Smith with you – Surgery Center of Oklahoma. Thank you for joining me in this video blog series.

Prior to putting our prices online, my thoughts about pricing were quite flawed and I think have evolved and I’d like to share that with you. First of all, I understood that prices were signals and that was very appropriate. I think that prices are signals that connote scarcity, shortages or surpluses and they’re signals between buyers and sellers that are very important. I’ve understood that for quite some time.

But when I realized that something was really terribly wrong in healthcare, my first thought at the Surgery Center was that I need to find out what people are paying everywhere else and get those prices, find out what those prices are so that I’ll know how to beat them and I’ll make a better deal.

And then I thought, no, I need to do the work as the seller. I need to decide what my prices are and tell the buyers. Then I decided to basically open a website and tell everyone what these prices were. Today in healthcare, it doesn’t really work the way that I went through that. People are always asking what are the prices so I can compare, so I can beat them, rather than put their own prices out.

I think as I’ve thought through this over the years… and we’ve had our prices online now for over six years… I’ve come to the conclusion that it’s the obligation of the seller to provide and display prices to the buyers. It’s the obligation of the seller to do this. It’s not the obligation of the buyer to discover prices that are probably hidden. And in healthcare, most of the time they are. As a seller, if I say ‘here is what I am, here is what I do, and here is what I charge for it,’ then the buyer can very deliberately determine whether that represents a value or not. They can comparison shop. And they can do it without revealing anything or providing any commitment whatsoever to me, the seller. This is present in every industry in the U.S. but it is largely absent in healthcare. Fortunately it is a growing phenomenon and more and more people are realizing that it is incumbent upon the seller to provide prices.

If buyers provide prices like the government, they always get it wrong. Fortunately the government ultimately gets everything wrong. If they guess what my price should be, they’re either going to guess too low, which means I’m not going to provide the service, or they’re going to guess too high, which means resources are wasted.

Any attempt by anyone in a top-down central planning type of fashion to guess what the prices for services or products should be, is going to be wrong. Real prices emerge from competitive activity. The market clearing price where the buyer and the seller have each found their optimum space… the market-clearing price is revealed to us all through competitive activity. And it emerges from competitive activity. It is never imposed from top down.

This was a bit of a flaw in my thinking before we put the prices online. And now I’m convinced this is the only way that you can ever have rational pricing in anything – including healthcare. I wanted to share these thoughts with you. Thank you for joining us. We will see you next time.

This is the transcript from my latest video blog. To view it, visit my new blog page at SurgeryCenterOK.com.

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Hello, Dr. Keith Smith with you – Surgery Center of Oklahoma. Thank you for joining me in this video blog series.

Well, April 15th has come and gone and, as Chris Rock famously said, “You don’t pay taxes – they take taxes.” And many of you now understand that the Unaffordable Care Act was simply a tax increase. It was not well-intentioned, meant to give people coverage – it was intended to make the purchase of insurance mandatory. And that is very good for people who are selling this insurance, if you want to call it that.

You’ve also understood that it’s a tax increase. If you have not guessed properly about your income, then you owe some of the subsidies that you received if you have one of these plans. If you have decided you want no part of ObamaCare, and you didn’t buy these policies, then you’re beginning to see these tax penalties appear on your tax return. …What choice do you have? There’s no way out, right? Wrong!

Check out Samaritan Ministries. This is your way out. The people at Samaritan Ministries have long understood that the problem with healthcare in this country was not a lack of coverage, it was the  ridiculous cost, it was the ridiculous price. And they have found facilities like mine and have heavily promoted what we’re doing with our price transparency. And ultimately, lots of Samaritan Ministries members have come here.

The way it works is, rather than buy insurance, you share the burden of your fellow members. It’s truly a beautiful, cost-sharing ministry and it’s something that I recommend you check out. They have a huge infrastructure and they are set up to absorb as many members who come at them, I believe. And so there is a way out. And you’re not in a position where you have to buy these policies from the government or be uncovered. You can join Samaritan Ministries and that’s what many many people are doing.

Samaritan Ministries  underwrote this documentary:  Wait Till It’s Free, by the brilliant movie producer Colin Gunn. I highly recommend you go to the website or the Wait Till It’s Free website and get this documentary and check it out. There’s a who’s-who of folks that star in this documentary: Daniel Hannon, one of the politicians in Great Britain who’s very outspoken about national healthcare. Yours truly – I’m in there.

John Mackey is also in there. John Mackey, as many of you may know, is the CEO of Whole Foods.  And he makes a statement in the video. He says “government fundamentally does not work.” And I agree with him, except I would add a caveat: government fundamentally does work for the few folks who are on the inside, for the people who know the rules and for those who brought their checkbook to D.C. to buy favors. Government works very well for them. And this has been going on for quite some time.

For the rest of us, government doesn’t work at all. It doesn’t work at all particularly for healthcare. His comments are very insightful and brilliant. It’s a wonderful video. Again, Wait Till It’s Free.  I cannot say enough good things about this video. And about Samaritan Ministries in general. There is a way out. Check out Samaritan Ministries online. They have a great website.

I hope this has been informative and I think many of you will be relieved when you see what they have for you on their website. Thank you for joining us. This is Dr. Keith Smith.  We’ll see you next time.

For more information:

www.samaritanministries.org

www.wtifree.com

www.surgerycenterok.com

I think it is good to be alert to any discussions that are “downstream of a flawed premise.” Let me explain.  When I hear, for instance, that the “flat tax” is preferable to the current income tax, I think to myself that this is a discussion of the knife versus the axe, a conversation far downstream of one addressing government spending or the very legitimacy of denying someone their earnings.  After all, victims don’t generally care what the mugger does with their money.  They just resent being mugged and no discussion about whether the mugger used a knife or a gun will likely provide any solace.
Similarly, I would argue that arguing for everyone to have health “coverage” is far downstream of the more original problem:  the cost of healthcare.  To provide “coverage” for everyone in the current climate of gross overcharging primarily serves the interests of those who employ the “what can I get away with” method of medical pricing.  The fierce push back against true price transparency by the cronies in the medical industry makes more sense in this context, as price honesty denies them access to everyone’s blank checkbook as the health cronies are well aware.  
Supporters of government-guaranteed “coverage” object with the following arguments.  First, coverage is equated with healthcare.  While millions of Canadians streaming across the border to secure their health needs could be used to refute the idea that coverage is synonymous with care, this disconnect has become more apparent in this country.  Each passing day reveals Medicaid and Medicare “coverage” to be a “black mark,” an actual obstacle to obtaining care, as these government programs and their associated rationing through price controls and hassles are creating the lines the central planners intended. Physicians are either dropping out of these programs altogether or they are limiting their exposure to patients with this “coverage.”  
Another objection points to the relief from financial devastation that having “coverage” represents.  Keep in mind that not only are well over half of the bankruptcies in this country medically related, but almost three quarters of those filing for medical bankruptcy have insurance.  This points powerfully to cost as the root cause of medical economic ills.  Acknowledging this is a slippery slope for the objector, however, for no economic system better provides for resource allocation than the market and the cronies and their government pals know this as well as anyone.  The market is the only source of price deflation with simultaneous improvement in quality. This powerful competitive mechanism has brought affordability to countless products and services in all industries and has begun to bring rationality to health care pricing as more physicians and facilities honestly post their prices for all to see.
Rather than focus on “coverage,” which allows the cronies to continue their financial feeding frenzy, we should remain unalterably focused on cost.  The competition unleashed will result in a medical price deflation the likes of which will cause even the most skeptical objector to re-evaluate the role of “coverage” in the provision of payment for health care.  This is no prediction.  This is exactly what is happening here in Oklahoma where so many health professionals have embraced the same market discipline every other industry must endure.  The reasonable prices and high quality of care, have had such a wide appeal that Oklahoma City has evolved into a medical tourist destination for many patients far from here, while simultaneously bringing savings in the millions of dollars to those who actually pay for healthcare, locally.  This is my answer to another objection from those who claim the inapplicability of market competition to health care.
Whether the focus on “coverage”  is a deliberate distraction by the crony propaganda machine or a well-meaning but misguided attempt to provide better access to care, we must keep our eyes on the “price transparency ball.”  The Oklahoma market is already harshly judging those attempting to avoid this gaze and I believe this trend will continue as long as we identify, challenge and reject conclusions downstream of their flawed premises.

G. Keith Smith, M.D.  

www.surgerycenterok.com

www.marketmedicine.org

I laugh every time I see headlines bragging about the number of people enrolled in “Obamacare.”  What choice to people have, after all?  "Buy this crappy insurance plan (that you wouldn’t buy unless you were forced), or face the wrath of the IRS bayonet.“  And then the bragging begins about how many are enrolled.  

This is no different than someone at the Department of Motor Vehicles bragging about the number of license plates attached to cars.  Or as one of my sons pointed out, this is no different than a blood diamond mine overseer bragging about the low rate of child unemployment in Sierra Leone.  What choice do these folks have, after all?

"The state is that entity whose ideas are so good that they have to be mandatory.”  This is one of my favorite sayings.  The truth is that over time, fewer and fewer people have assigned value to health insurance products in the marketplace, and consequently fewer people bought them.  Here is the part, however, that many find hard to believe. The insurance industry did what many industries do, and faced with a smaller demand for their wares than they would like, they greased palms in D.C. to make the purchase of their product mandatory.  Poof! “Obamacare.”

In order to “sell” this robbery, the D.C. spinners did what they always do and put on the “it’s all for your own good,” show.  Who could possibly be against people dying in the streets without healthcare?  As many lies as we have been told by government power brokers over the years, I continue to find it hard to believe that so many reflexively find these liars believable.  

Some people believe that the government constantly lies but never about foreign policy or war.  Some people believe that the government lies to protect corporate interests, but never about public welfare programs.  I propose that we all entertain the idea that we are being lied to about everything anytime the government is involved.  This doesn’t mean that everything is lies.  Rather, I am recommending this as a starting, default position, just to be on the safe side.

Lew Rockwell has said that “..you only know for sure that something is true when a government official issues the official denial.”  The government has even admitted to lying about the number of people enrolled in their mandatory “health insurance” scheme!  Good old Jonathan Gruber has admitted to a massive deception scheme and confidence trick in connection with the passage of Obamacare.  The big hospitals are getting richer, the big insurance carrier’s profits are soaring, and many continue to believe that Obamacare was all about the poor and uninsured.  

In spite of everything, I remain optimistic that the competitive power of the free market will rescue us from the central planners’ attempts to line the pockets of their pals in the medical industrial complex.  Although government-run health plans everywhere invariably resort to brutal rationing and euthanasia to balance their budgets, the increasing availability of high quality, affordable health care in the private marketplace in this country will serve as a refuge for those for whom Obamacare was ostensibly intended to help.  We are already seeing this at our facility, where surgical procedures are regularly purchased for amounts far less than Obamacare’s high deductibles.  If you think that the beneficiaries of these high deductibles are the insurance cronies whose claims exposure is minimized, you go to the head of the class.

High quality, affordable care with the preservation of patient choice. This is the goal we all share.  I believe the competitive marketplace provides the only path to this goal and more evidence is accumulating that serves to vindicate this belief.  

I would like to encourage the Obamacare believers to keep your eyes on the medical price deflation that is happening all over the country, here in Oklahoma, in particular.  This is not due to bureaucratic price controls and rationing, but due to the healthy competition that has arrived in spite of all federal attempts to prevent the appearance of this vibrant marketplace.  Faith in the marketplace is more well-founded, I believe, than faith in known and admitted liars.  

G. Keith Smith, M.D.

www.surgerycenterok.com

www.marketmedicine.org

Brandon Dutcher, senior VP at the Oklahoma Council of Public affairs, sent me this Washington Examiner article by Tim Carney.  Mr. Carney assumes that his readers are familiar with King v. Burwell, a case before the Supreme Court that most agree represents a death blow to the Unaffordable Care Act.  For those who are not familiar, King v. Burwell will disallow Obamacare  subsidies to states which did not set up state exchanges.  The “law” clearly states that these subsidies will be distributed through “exchanges established by the states,” making no other allowance, namely an exchange of federal origin.  Oklahoma’s Attorney General Scott Pruitt has one of the leading roles in this court case, a case most agree is the last stand by states wanting nothing to do with Obamacare shoved down their throats.

If the good guys win, Obamacare will be irreparably crippled in the states (37, I think) that did not establish these exchanges.  Without these subsidies that hide the true cost of the “insurance,” the premiums will be exorbitant, the individual mandate will vaporize and no penalties can be applied to “non-purchasers." 

Back to Mr. Carney.  Whose support of the King v. Burwell effort is absent?  Mr. Carney rightly ridicules the liberal rag "Mother Jones” for claiming that King v. Burwell has no merit because corporate healthcare cronies aren’t supporting it. My favorite of his analogies is this one:

“If cutting defense spending is such a good idea, why is the military-industrial complex opposed?”

This is after all, the same logic used by the folks at “Mother Jones” in forming the basis of their skepticism of King v. Burwell.  Mr. Carney’s humorous article unveils the cronyism that forms the basis of the Unaffordable Care Act.  For more evidence, read this report about record setting revenues at one of the nation’s largest “insurance” carriers.  Cronyism like any other scheme or conspiracy survives only as long as few know the truth.  These two articles should help provide courage to those remaining skeptics to open their eyes to the true nature and purpose of Obamacare.

G. Keith Smith, M.D.