The government. When invoking those words, it is usually federal government that comes to mind rather than state. Likely, this is the by-product of influences that want to direct attention to the far instead of the near, the purpose being to get us to believe that there are limitations to what we can do about the far compared to the near. But is that true? Is a government physically closer more controllable than one physically further? Just four examples from my life should suffice to defeat that notion.

As a physician, I am required through various professional interactions, to carry a medical malpractice policy. Recently, due to a change in my work situation, I opted to terminate my policy and become insured by the one my new group uses. After several weeks of lacking a copy of the policy, I requested it from the carrier. That request was denied. I contacted the carrier who asked if I had any specific questions. I said yes, “where is the copy of my policy?” “We do not supply one” was the answer, “we just answer any questions you have.”

So, I got smart. After several missteps, I was able to locate the state agency that regulates insurance carriers which underwrite medical malpractice. After some back and forth on the website and phone, and four months later without a firm answer as to where the copy of my policy was, I received this inquiry from the state: “Do you have alternate contact information for the insurance carrier since they never answered our inquiry?” Lesson learned: just because the state “regulates” an industry it does not mean they know who in the industry they regulate.

Eight years ago, I bought a new car from a dealer. I will not disclose the maker. Each year, the same auto dealer inspected it. Last year, the service rep notified me that the subframe rusted, creating a hole. The subframe needed to be replaced, otherwise the vehicle would not pass inspection. There is a cover over the subframe (held in place by several removable screws) which apparently was never removed during inspections. What started as superficial rust that could have been scrapped away and treated, completely eroded the steel. “Lack of adequate drainage of the road salt” was the answer I received as to what occurred. It was apparent to me that both a design flaw and improper vehicle inspection were responsible.

So, I got smart. After fits and starts, I found the state agency that “regulates” vehicle inspection stations. I submitted a complaint, summarizing the relevant facts such as using the same inspection station yearly and the apparent lack of proper inspection, as evidenced by review of the service reports and comparing it to the vehicle’s current condition. After much phone discussion, the result was that there was nothing the agency would do, but perhaps I would like to seek counsel. Lesson learned: Just because a state agency “regulates” a business, it does not mean that it will investigate accusations of potential fraud against those it claims to regulate. Unlike medical care, what isn’t documented may have actually occurred, whether contained in those documents or not.

Years ago, in the building I worked in, there were two physician groups. The physicians in the other group decided they needed to expand, and they moved to another location. Having seen in person certain of their business practices, I got wind of a much larger “enterprise” they were involved in and one that directly affected me.

So, I got smart. I contacted an attorney who dealt with such matters, and after discussion, a whistleblower action was taken up with the DoJ under the False Claims Act.

My attorney and I met in a state office building with officials of the state and federal government including the Office of the Inspector General. Over several hours, we reviewed the details of the filing we submitted and answered everything to the apparent satisfaction of those present. At the meeting’s close, I was instructed that all contact would henceforth be between my attorney and one of the federal agents present at the meeting.

After months passed, my attorney called me. “Bad news. The case is being dropped.” “Why?” I asked. Answer: the federal government agrees with the facts of your case and would pursue it; however, it requires the consent of the state to proceed, and the state will not consent. “Why?” I asked. My attorney also asked but did not receive a direct answer. Case closed. Lesson learned: government at any level can ignore the law, there is no reasonable mechanism to force their compliance, and there is no accountability for their action or inaction.

I live in a state where consolidation of hospitals has been on a tear for decades, leading to the death of the community hospital either through lack of local control or outright closure. For physicians, this can lead to new burdensome standards, altered referral patterns, or worse, which I will get to.

When hospitals merge, there is a review by the state attorney general and a degree of oversight by the Federal Trade Commission, namely, the Bureau of Competition, with the proposed merger either approved or denied. In my area, there is a large medical center that decided it wanted to fold in neighboring community hospitals to create a bigger “system.” One at a time, of course.

So, I got smart. I contacted the AG’s office in writing voicing my opposition, explaining the impact this would have on medical care in the community. The merger was approved. However, it led to physicians being kicked off the medical staff of the smaller hospital if they were not already employees of the medical center. I contacted the AG’s office and had a phone meeting with from memory, four or five members of the AG’s office. I pointed out what occurred, and I could hear each in turn ask the other “Did you realize this could happen?”

Flash forward one or two years, and the same medical center filed a request to take over another community hospital. Once again, I contacted the AG’s office and reminded them of what had previously occurred. Assurance was given they remembered, and the same situation would not occur. Promises, promises, approval granted at the state level.

So, I got smart. I wrote to the FTC’s Bureau of Competition. After months, the head of the agency called me. After discussion in which I rehashed my concerns about what occurred, and sensing I was getting nowhere, I asked straight out “how do you define a monopoly” and without much hesitation, the response I received was “That is a good question.” There was no clarification, but I knew, and he should have known, about the concept of “court precedent” and when applied to this case, about 60-70% market dominance would define monopoly. Lesson learned: government will protect government whether it is laterally or hierarchically situated.

So, to summarize, dealing with any form of government is akin to “the house always wins.” How could it not be when the meaning of words are not static, when words and concepts may be inherently vague, prosecutorial discretion can be abused and unaccountable, precedent can be ignored, new precedent formed, or on the flip-side, be adhered to when patently absurd, government can be designed to protect itself and those whom it choses to protect, and lastly, the only option “allowable” is to vote ourselves out of any and all situations we find unacceptable.

The state and I are in an abusive relationship, the consequences of which you are not immune to.

Image: RawPixels