Dust over Hooker, Oklahoma 1937

Oklahoma appears to be struggling to find enough providers.  The Oklahoma Legislature and Board of Medicine have blocked the MOC gravy train being run by the ABMS.  One examle is the Family Practice Board – ABFM.  The Family Medicine Board make out like bandits in 2012:


…ABFM (reported ) $ 112.4 million …in total assets in 2012 with $ 60.5 million reported in gross receipts….

Meanwhile, in December 2015, Oklahoma’s Health Care Authority admits to being in deep trouble.  The Oklahoma Health Care Authority (OHCA) board approved a three percent across-the-board provider rate reduction at their Dec. 10 board meeting. Yes, but it wound up being nearly 10%.  Ominously, the OHCA estimates in December that it will need an additional $37.5 million state dollars over the current year’s base appropriation to operate the program as it is today.


Boise City, Oklahoma

Oklahoma’s state Medicaid agency proposed slashing provider rates by 25 percent earlier this year.  OK providers are encouraged to comment, which they did:


We are two providers in primary care and because of the 25% reduction in payments along with last years 9.9% we cannot accept this proposal and further more our doors will close forever…….this really helps recruit providers doesn’t it, NO!!

OHCA Staff Reply
The OHCA appreciates your comments. The agency does not take these cuts lightly and understand that the 25% reduction will mean difficult decisions for providers. The specific posting that you responded to was to inform the public at large that the agency is submitting a request to the Centers for Medicaid and Medicare Services (CMS) requesting a 2 year extension to the existing SoonerCare waiver. We will be happy to forward your comments for the 25% rate cut posting to the appropriate staff for response.  Thank you.

Either Oklahoma has the world’s stupidest and most arrogant bureaucrats, or it doesn’t.  Either way is ominous.  The aggregate rate cut over two years will be 32% of the 2014-2015 reimbursement year’s.  I suggest that even the stupidest bureaucrats understand the difference between a budget increase and a budget deficit.  After all, they live and die by the bureaucratic budget.

The Oklahoma bureaucrats understand, more so than the average person, that a business income cut of 32% is unsurvivable even in a business making a two-digit profit margin, which are few and far between.  They understand that when the system collapses, as is unavoidable, they will be hauled before the Legislature and pilloried for “promising to make it work.”  They will, of course, make such promises under duress – that is the nature of bureaucrats.  they have to create plausible denial, and they will, along with all the other states in the US.  I read the reply of the bureaucrats above to convey the grief of inevitability, rather than just the arrogance of denial.

If something is given a mandate but no means to carry it out, it will fail, in the same way that cardiomyopathy results in “cardiac failure.”  There is no intransigence intended by the failing heart, of course – it does the best it can, given the limited capacity that it has.  Treating end-stage cardiomyopathy involves maximizing the effectiveness of what is left behind.  But every cardiologist will tell you, the only relative cure is a transplant – and Medicaid has none.  American healthcare is failing, but not from lack of ideas, but from lack of foresight some 40 years ago.  Oklahoma may lead us by 2020 into the quasi-stable dawn of American Third-World Healthcare.  We are only a few heartbeats away; and states such as Connecticut and Massachusetts and others will glide over the waterfall shortly after the poor and flyover states fail.  This is written, as though in the stars.

During the last flight of the Okies, Steinbeck commented on the tons of oranges being dumped in California – wasted – while tent cities contained starving children.  Like the rest of the country, he merely asked – WHY?  Now, we see cushy medical specialty boards wallowing in the millions of dollars, while rural states struggle to retain providers.  Why?