I have a suggestion for all of those federal workers who are concerned about a government shutdown, who are concerned that they won’t be paid if a budget compromise isn’t reached. To all those who already have better insurance and better benefits than most in the private sector; for all those whose jobs pay more than equivalent private sector jobs for the same activities. Do what hospitals do. ‘Go to your jobs, and do the necessary work anyway.’

It is ironic, but hardly surprising, that the government suddenly so concerned with being unfunded continually demands unfunded work from hospitals and medical providers. Or at best, expects underfunded work.

I ask you, friends and colleagues in the world of medicine, how many physicians see patients at the markedly reduced Medicare rate, the criminally reduced Medicaid rate or the tyrannical EMTALA rate of zero!

How many physicians, in attempting to do the right thing, find their care denied by Medicare on technicalities, or suddenly find themselves targeted for fraud for misunderstanding the complexities of the already inappropriately low compensation the government pays them?

Untold numbers of hospital administrators struggle to keep their facilities afloat because they are mandated, by virtue of accepting Medicare, to see all comers. They provide care for every abusive, abusing, non-compliant, non-paying individual who passes through their doors. Day after day, these administrators, and the physicians who work in their facilities, conduct their ‘business’ in an unfunded environment.

Not only so, but they conduct it in an environment of high litigation risk (which the government refuses to mitigate), and they conduct it under the ever watchful eye of a federal government licking its hungry lips in the endless search for violated rules, missed guidelines, and perceived inadequate ‘performance,’ all with an eye to either litigation against, sanction of, or refusal of payment to those hospitals and providers actually caring for the sick and dying.

As a consequence of this unfunded environment, some hospitals close, many physicians are leaving hospital care in droves, nurses are being laid off, nursing coverage is being cut, patient care is ultimately compromised and the federal expectations and rules grow ever more onorous. But we keep going back, and doing the best we can, day after day, year after year.

Unfunded government? If all of those agencies are really that important, really that critical to the well-being of our citizens, they’ll do the right thing regardless. Like we do.

But then, what are the odds?

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