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

The effect of Newsom’s harsh Medi-Cal government run healthcare throughout California and beyond has been to herd both doctors and patients into a trancelike and untrusting state of mind. The affection between the two has turned into dislike. Call it herd mentality. Doctors think that since their fees have been radically cut over the years by Medi-Cal, California patients caused it by voting for more crackdown in the name of price fixing, and thus the patients are at fault. On the other hand, patients think that doctors don’t care anymore, but they are unaware that Newsom is literally stealing the profit due to physicians as he convinces them that doctors continue to price gouge.  Such skillful deception and manipulation of the emotional and financial health of doctors and patients is disgraceful, and the worry and anxiety disrupt the physical  health of both.  

Both doctors and patients have directed their attention and remaining hope to Medi-Cal, a very tiny group of tyrannical, unbridled, seemingly unstoppable cutthroat abusers. These people exercise arbitrary, unauthorized, addictive power, and stir the fire of resentment among Californians by the art of prejudice, rewarded by the “high” and exhilaration of their destructive  habit.

Newsom is at  fever pace full throttle now, and he has “burned the ships” along with his contemporaries, under the dome,  just fifteen blocks from one of the hospitals he conquered which I practiced in and about twenty-five blocks from the hospital I trained in, and in every other hospital in the state. He and his predecessors/successors have been at it for a long time. Get in line and get (or don’t get) your government run healthcare, right into your grave.  After all, there is no other option.

Recently, a focus group of California citizens in the vicinity of Sacramento asked me some very wise questions about their recent interactions with Medi-Cal, which reflect their real time suffering and concerns. Two patients, whose courage I admire, presented their own clinical  experiences, followed by a series of questions from the group tending toward two topics, namely access and fairness in the distribution of Medi-Cal. My answers follow each.

Patient number one: Doctor, I am in my fifties. I am a Medi-Cal enrollee, and I’ve been waiting two years for a colonoscopy. The list of doctors is so limited that the nearest doctor that takes Medi-Cal is an hour away.  I live in Roseville, which is a nice city, not out in the boonies like Truckee.  I feel demeaned because I can’t get the care I need.  I have been paying out of pocket to see a doctor near me that I trust.

Patient number two: Doctor, I am a friend of patient number one.  I am similar in age and on Medi-Cal.  I was having some serious health issues and because of Medi-Cal I could not find a doctor who could see me within weeks despite the urgency.  I finally went to Roseville Sutter and paid out of pocket for the visit.  They took me in for emergency surgery and told me that if I hadn’t shown up that day, I would have been dead within two days.

Following are the group’s questions.

1. How many people are dying without adequate care.  Answer:  All insurances, including Medicare, those insurances you pay for, or your boss pays for, or taxpayers pay for (which is Medi-Cal) are the source of 20 cents on a dollar billed  at best.  Enthusiasm in the work of physicians and surgeons drops off accordingly.  Inadequate payment means inadequate care for all Californians.  The two patients presented above demonstrate the point.  No doctors, no care.  I applaud the doctors remaining in the private sector willing to take cash for service.  They are saints and far and few between.
2. Is Medi-Cal beneficial and worth it?  Answer:  No and no.  Medi-Cal is dangerous and is not worth the paper it is printed on.  The clinical presentations above again demonstrate the point.  Patient one needs and has needed a colonoscopy for two years.  It is standard of care to be scoped at age fifty.  There has been a negligent delay in service, in which time colon cancer could have been detected and if present, now metastasized.   She would die of metastasis because of it.  I pray that she can be seen by a gastroenterologist and  her colonoscopy is clear of lesions.   Preventive care has been neglected by Medi-Cal.  Patient two likewise needed to be seen by a physician, but she wasn’t.   She nearly died, if not for the help she received at Roseville Sutter.  There is no emergency room in the USA which will deny emergency service to any patient, but it is disgracefully wrong to allow the surgical illness to advance that far along.  The lack of patient access was almost lethal here.   The prejudice of Medi-Cal is demeaning, by design, and doctors have the right to choose whether they will see Medi-Cal patients. 
3. Is Medi-Cal a hinderance that is causing deaths?    Answer:  Yes.  Medi-Cal is a roadblock or a wall between a doctor and a patient.  Availability is one of the six covenants of the Hippocratic oath, and availability requires fair market payment for services rendered.  Medi-Cal has sculpted (or engineered) amoral, unenthusiastic healthcare providers (workers) who lack the experience, judgment, skill, boldness, compassion and empathy of board-certified physicians and surgeons.  For a third time, our two patients above demonstrate the point.  Access, access, access.
4. Is Medi-Cal a net zero gain?  Answer:  Yes, absolutely.  A net zero gain, or net zero game is the exact opposite of a net zero budget.  Newsom’s budget is deep red and one- sided and Medi-Cal reflects that process by taking without giving back.  It is a losing and unsustainable proposition.  Net zero budgeting is virtuous and recommended for every fiscally responsible Californian.  It means that at the end of a month, my expenses are equal to my income with a net zero sum.  That means that I pay bills, like medical insurance (unless my boss or the government pays it for me),  homeowners insurance, fire insurance, savings, mortgage, etc.…  including taxes, and there is no outstanding debt (other than my mortgage payment if I own a home and in that case property taxes).  Medi-Cal taxes you heavily and hoards the booty by cheating doctors out of their due income and you out of your needed physician’s help.   Net zero gain means no access.  As a side regarding Newsom’s net zero gain via Medi-Cal  is the issue of CalPERS, or California style Medicare.  The public employee’s retirement system has a one trillion-dollar unfunded liability which is camouflaged by property taxes.  That debt service will never be met.
5. Are the stories above anomalies or are they the typical experience of someone on Medi-Cal?  Answer: Sadly, these stories are not anomalies.   They are the  experience of anyone in California seeking medical or surgical assistance from doctors and hospitals who accept health insurance payments.  The reason they are not typical is because most Californians haven’t gotten sick enough to access the system.  In other words, chronic and mild illnesses are easy on Newsom’s budget but get really sick and admitted to the hospital and that gets his attention.  Nor do average Californians worry about how much they are paying for Medi-Cal or any insurance (it’s all semantics), because after all, their boss pays for it if they are still working, or  the government is paying for it if they are retired, and of course both earned the money being paid out by their diligent work ethic. They are well and not thinking about going to the doctor, and they will deal with that problem when it presents itself.  Watch an ad on TV, listen to the radio, spend idle time on the internet, or look at a billboard on the freeway and you will have confidence that all is well in medicine.  It’s called herd mentality.
6. What does Newsom have planned for the illegal aliens coming into California when it comes to Medi-Cal government run healthcare?    Answer:  To answer this question, I am reminded of a chat I had with an anesthesiologist colleague in my twilight years as a Sacramento surgeon.  He was working Locum Tenens in obstetrics down in San Diego to augment his dwindling income in Sacramento. Epidurals remain a big deal in obstetrics. He laughingly said a term used in the hospital he worked in was “no pay Jose.”  Of course, he was well paid by the hospital for services rendered because they lacked adequate numbers of staff anesthesiologists to keep up with  patient demand. I responded, “Welcome to the world of Medi-Cal.”  The result?  A twofer, two for the price for one, both Medi-Cal enrollees, and both probably becoming American citizens who will reside in California. The newborn likely pulled mom in with him or her.  That’s up to Newsom. Independent of obstetrics patients, Medi-Cal will honor any citizen anywhere in the USA and will not deny access to emergency care. That was the plan of every Newsom predecessor, and it will continue with every Newsom successor. So, my answer is illegal aliens will be automatic enrollees into Medi-Cal.  This process is not fair to legal citizens.  It is infuriating, but not the illegals’ fault.  It is Newsom’s. 
7. Will illegal aliens be given healthcare and what is the current level of free care they receive?  Answer:  Yes, they will, and they are being given healthcare.  A hospital in Denver is flooded with illegal aliens right now and is demanding financial help from the federal government because many legal patients entering their hospital must wait while the illegal aliens are being treated.  This is an issue of access and fairness in the distribution of goods and services.  Medi-Cal is unfair to American citizens and preferentially accommodating illegal aliens, and that is prejudice.  The current level of free care the illegal aliens receive  is exactly the standard of the industry, which is essentially no bang for the buck.  It’s common sense.  You get what you pay for. 
8. How will (or how does) the presence of illegal aliens impact the level of Medi-Cal healthcare legal residents receive, if there is an impact?   Answer:  It is very impactful right now.  Illegal aliens get in line, just like legal residents do, and they are seen in their order of presentation.  That means longer waits, as demonstrated by the two clinical presentation patients above.  Danger while waiting for an unenthusiastic healthcare worker to see you, to formulate a diagnosis, and proceed with therapy based on political science fiction instead of upon medical scientific method to make you well is just not right.  The issue of preferentially allowing illegals to take cuts is an injustice.  It is discrimination and racism  of the highest order against California citizens.  There is a paradox however, as illegal aliens are rejecting Newsom’s Medi-Cal because it doesn’t stand up to the standard of healthcare in the third world countries from which they are fleeing.  No pay Jose, no pay Chinese, no pay Brazilian, and on and on.  As an aside, I experienced testimony from a very experienced elderly gentleman who was able to escape from Castro’s Cuba and find peace and freedom in America.  He spoke of the healthcare system in Cuban hospitals, and he said, as relates to physician compensation….”A doctor and a taxi-cab driver are paid equally”.  This reminds me of California, where the compensation of an Uber driver is equal to a Newsom’s California healthcare worker.  Where does that leave patients?

Here are two telling statements that physician colleagues of mine made, one escaping Medi-Cal control, and the other succumbing to it.

Physician one: “Show me a doctor still working over fifty-five years old and I’ll show you a doctor who can’t afford to retire”.

Physician two:  “I do the bare minimum for Newsom.  The patients deserve everything they are getting. Doctors do not care anymore”.

There is a heartbreaking statistic that makes me very sad.  The average medical school graduate today has a two-hundred fifty to five-hundred-thousand-dollar student debt.  In an earlier time, a medical student was financed by his or her parents, as in my case.  It is impossible to have a side job during the rigors of medical school.  It is also impossible for these dedicated young physicians to even consider buying a half-million-dollar home. They must pay back their creditor, the government, and that will be very hard for them to do on the salary of an Uber driver. Where does that leave the patients?  And I’m not knocking Uber drivers. They are very pleasant people. I’m knocking Newsom for driving his bizarre, unaffordable, and dangerous agenda down our throats, and his attempt to wreck your and my California Medical system.  He will not get away with it. 

This is part II of a three part series. Part I is here.