Medi-Cal and Its Deleterious Impact in California Medical Care: The Cause

Medi-Cal is California style government run healthcare and as such is the poster child of our national and even our global government healthcare systems. The concept of the government running anything, let alone medical care, is a mistake, a misunderstanding and an illegal misuse of arbitrary power when considering who should  be in charge.

My experience as a general surgeon with Medi-Cal in Sacramento for the last two decades of the 20th century and beyond was comprehensive. My dealing with Medi-Cal was a significant part of my practice along with most private healthcare insurances, Medicare, and the Sacramento County Medically Indigent Adult (MIA) Program.

The first time I heard the term Medi-Cal was in 1980 when I arrived on the scene at the UC Davis Medical Center (UCDMC) in Sacramento for my internship and residency training in general surgery.  UCDMC was almost brand new at this location as well, and my mentor, F. William Blaisdell, MD, was instrumental in changing the Sacramento County Hospital into a level one trauma center, none more impressive in the USA.

UCDMC was in the perfect location, right in the center of Sacramento, which just happens to be the seat of politics for close to 40 million Californians and the home of thousands of government employees, lobbyists, political staffers, politicians, teachers, union employees and so forth.  It is also the intersection of Interstate 80 east to west and Interstate 5 north to south.  There are many car wrecks in the area, the source of a lot of blunt trauma.  Sacramento is the source of considerable penetrating trauma, the so called “knife and gun club.” The indigent population continued to frequent the “new” teaching county hospital.  Blunt trauma patients generally had medical insurance and government employees and teachers always had medical insurance whereas penetrating trauma and indigent patients did not.

For five years as a resident, I learned how to be a general surgeon and was paid the salary of a learner by UCDMC, characteristic of any training resident in any residency in America.  That salary was just fine.  How UCDMC was paid or how much payment was received was none of my business.  In retrospect, I believe UCDMC was a feeding ground for the predatory Medi-Cal, as academic physicians and surgeons and university administrators do not appear to be very good at business.

When finishing my residency in general surgery I decided to remain in Sacramento and go to work in the private sector and obtained admitting and surgical privileges in the three downtown metropolitan hospitals.  

A big feature of my early career was emergency surgery, and I frequented all three ER’s.  The ER doctors appreciated my availability, as many older and established private practice surgeons backed off as a “rite of passage” so they could get sleep at night and focus on their elective surgery cases.  That meant more work (fun) for me, as I built my reputation and my business as most young surgeons who ventured out on their own did.

So, when I would operate on  Medi-Cal patients, I was shocked to see just how cheap the Medi-Cal payment system was when I started to bill the government myself in this new private practice setting that itself was absorbing the burden of more and more Medi-Cal patients. No ER anywhere in the USA would turn away any patient seeking medical treatment. Compared to the private insurances, including Medicare, I was paid about 90 cents on a dollar while Medi-Cal paid about 30 cents on a dollar and that is not good business. It was and remains nonsense.

Just as bad, my ER doctor colleagues would introduce Medi-Cal patients when asking me to see them in the ER  as “Golden Bear” because of the distinctive Medi-Cal insurance card displaying the state animal, the grizzly bear.   Translated that means cheap or pathetic payment, and they would always apologize.  They would describe insured patients as “solid citizens.”  Those older and more seasoned surgeons entering their rite of passage discussed above were also averse to working with Medi-Cal patients because of the annoyingly low payment for services rendered and were happy I was dealing with them.  

One very important characteristic of Medi-Cal patients I dealt with in private practice that I didn’t recognize as a resident at UCDMC was their lack of appreciation and friendliness.  It didn’t matter whether they were Caucasian, Mexican, Russian, Laotian, or otherwise. They were generally grumpy and unappreciative and entitled. Late in my career I complained to my office staff once after morning rounds in the hospital that even a simple “thank you” would be reasonable and considered thanking these patients in the future for letting me operate on them. That was a hugely different  characteristic between Medi-Cal patients and other medical insurance patients, and the problem was and remains the responsibility of the administrators of Medi-Cal.

With time and abuse of both doctors and hospitals, Medi-Cal tragically expanded into all healthcare insurances in California such that by the turn of the century, government and closely allied healthcare insurance companies administered and still administer the payment of physicians at a rate of about 25 cents on a dollar. Californians were and remain clueless to this folly.  That was when I had had enough and stopped practicing general surgery in Sacramento.  Medi-Cal care gravitated to rock bottom and I blame Governor Gavin Newsom.   The buck stops with Newsom.

The abusive and deleterious impact on California medicine via Medi-Cal is not simply financial. Bad feelings and outright prejudice between doctors and patients have been conjured up by those controlling the “healthcare industry.”

It’s not the patients’ fault for the cheap payment of Medi-Cal health insurance and prejudice is not the fault of “well off people” in reducing Medi-Cal enrollees to the level of cheap, ungrateful scum.

It is Newsom’s Medi-Cal, and he knows it and he owns it

 Even worse, the sycophantic bureaucracy invaded UCDMC and indoctrinated medical and surgical academia, which is now completely on board with government run healthcare and this failing system is being taught to our young up and coming physicians. Doctors have become indentured servants.  The camaraderie between myself as a graduate of UCDMC and my prior colleagues in the academic sector became strained because of envy and a desire to destroy private practice surgeons on their part. Prejudice ensued among doctors.  

The enthusiasm of both doctors and patients is at an all-time low, and it is almost impossible for doctors to hide it. Burnout has killed the spirit of medicine.  All healthcare insurance companies, including Medi-Cal and Medicare are wolves in sheep’s clothing.  They have cheated physicians and hospitals out of their due profit in assuming control of the administration of “healthcare.”  Then they point their finger at those they have conquered and cry out “price gouging” and demand “price fixing” for the unwary Californians, as disguised humanitarian saviors of society.   They destroyed medical care and the providers of that medical care.   The economic initiative of a physician is gone, and survival is paramount.

Concomitant with this outright abuse of the medical profession is horrible abuse of the patient.  The healing initiative of innocent patients was systematically leached out by Medi-Cal, who has continued  to remind patients that the doctors and hospitals are price gouging, but they don’t include the price fixing they cruelly initiated years and years ago.   They know the doctors won’t speak up as they steal and boast that it is becoming harder and harder to put up with all the doctor theft.   The simple question is….”Where is the money?”   The way the taxation system is supposed to work is that you declare your income to the government and pay your taxes, but the way this system works is that the government steals your profit and taxes the doctors for the money they ripped off.  Where does that leave the patient?

Malpractice litigation skyrocketed.  The safety issue was pushed by the government.  A medical malpractice suit is a loser for a physician. A  cutthroat ambulance chasing plaintiff attorney and his highly compensated expert witness doctor with a great niche, along with a sympathetic lay jury and an activist judge is a formidable adversary for a doctor.  The government cries out, “Doctors are unsafe!  Hospitals are unsafe!”  Ironically, the government is absolutely correct, but they blame the very people they cheated, including the patients.  

The result? A massive decrease in the standard of medical and surgical care, a paucity of attention to detail, gross negligence, prejudice, replacement of doctors by healthcare providers such as nurse “practitioners” and “physician assistants”, flat-out danger, and literal death of patients on a large scale. 

The latest chapter of Newsom’s Medi-Cal strategy has greatly influenced the rookies in Washington, D.C. in the form of the PPACA or the “patient protection and affordable care act”, now the law of the land.  The hypocrisy in that law described in those five words is stunning. If Medi-Cal were forced to tell the truth, it would shout out:

“I’m cheap and I’m cheating your doctors out of the money due them.

I am forcing you to hate doctors and for doctors to hate you.

I am now powerful and wealthy and in control of all of you. 

I own you, and yes I owe you. 

What are you going to do about it?    

Whether you live or die is my decision.   

Don’t even think about trying to stop me!”