Alan Greenspan: “A government cannot become insolvent with respect to obligations in its own currency. There is nothing to prevent the federal government from creating as much money as it wants and paying it to somebody. The United States can pay any debt it has because we can always print the money to do that.”

Ben Bernanke: “The U.S. government has a technology, called a printing press (or, today, its electronic equivalent), that allows it to produce as many U.S. dollars as it wishes at essentially no cost.”

Scott Pelley: Is that tax money that the Fed is spending? Ben Bernanke: It’s not tax money… We simply use the computer to mark up the size of the account.

Statement from the St. Louis Fed: “As the sole manufacturer of dollars, whose debt is denominated in dollars, the U.S. government can never become insolvent, i.e., unable to pay its bills. In this sense, the government is not dependent on credit markets to remain operational.”

Question: I am wondering: can the ECB ever run out of money? Mario Draghi, President of the Monetarily Sovereign ECB: “Technically, no. We cannot run out of money.”

The US healthcare industry is experiencing a severe shortage of workers at every level, which has been worsened by the COVID-19 pandemic.

According to the American Hospital Association, the industry will face a shortage of up to 124,000 physicians by 2033. 

Meanwhile, it will need to hire at least 200,000 nurses a year to meet rising demands.

A study by consulting firm Mercer projected that the US would face significant healthcare worker shortages in the coming decade.

By 2025, the firm forecasts a shortage of more than 400,000 home health aides and 29,400 nurse practitioners. 

A major factor is demographics: People are living longer, requiring more medical attention as they do, while members of the aging healthcare workforce are starting to retire faster than they can be replaced.

Other reasons include burnout(overworked employees are leaving the profession at an accelerating rate); the rise in chronic conditions such as diabetes, heart disease, cancer, and Alzheimer’s disease (leading to overextended staff at hospitals and long-term care facilities); and the nation’s inability to produce enough doctors and nurses to meet growing demand (partly because of faculty shortages at nursing and medical schools).

Shortages of certain kinds of healthcare practitioners, such as nurses and certified nursing assistants, are also due to the relatively low compensation levels, relatively high job demands, and education requirements in those fields.

1. Our Monetarily Sovereign federal government has infinite dollars and infinite control over the value of its sovereign currency.
2. There is an increasingly severe shortage of doctors, nurses, other healthcare workers, and hospitals.

The Broken Medicare System Is Forcing Physicians Out — Yet another physician pay cut will prevent timely access to care by Rick W. Snyder II, a cardiologist.  November 20, 2023 In any career, 25 years of dedicated work is much to let go of. In medicine, it amounts to hundreds of patient relationships and the blood, sweat, and tears that go into starting and maintaining a practice.

Yet, after all that time, one of my physician colleagues recently had to let go of her beloved private practice — not by choice and not without tears for her dear, elderly Medicare patients who now face fewer options for care.

Her story is, unfortunately not unique.

Physicians and their patients have suffered through more than 2 decades of uncertainty caused by precarious Medicare funding.

We’ve seen how these cuts have forced unwanted changes in medical practices. While their practices stay open, the Medicare system underpays our nation’s physicians to the point that some are forced to make difficult decisions about which patients they can care for.

Eventually, when these practices barely have their heads above water, that “next round of cuts” proves to be the last straw.

Like clockwork, another Medicare physician payment cut is on the horizon for January.

I’m afraid the day is near — if not already here — that there will not be enough physicians to care for Medicare patients.

Physicians who participate in the program are forced to do more with less, which leaves no good choices. The situation hinders our ability as physicians to provide the complex, quality care these elderly and sometimes disabled patients need and prevents us from seeing as many Medicare patients as we would like.

Furthermore, it contributes to burnout and moral distress because we can’t do what we swore an oath to do: to put our patients first.

As president of the Texas Medical Association (TMA), I hear concerns from our physician members as they face ongoing practice viability challenges.

“If this additional [Medicare] payment cut goes through, in the midst of inflation and COVID causing rising costs for staff salaries and benefits, I would have no choice but to stop caring for these patients,” a worried physician shared with TMA.

“We are dying,” said another. “I can’t even keep a full staff. All the doctors I have referred patients to are leaving or gone.”

“I’m terrified for what this will mean for my elderly patients and their access to care,” yet another concerned doctor said.

“The mental stress of making ends meet is not good for patient care,” another colleague warned.

Not only is this system unsustainable for our nation’s physicians, but it’s also unfairly stacked against them.

It’s the same system that concurrently pays hospital-based clinics more for some of the same services an independent community physician provides. On top of that, Medicare helps hospitals cover uncompensated care.

I’m not saying hospitals don’t deserve to be paid for what they do. But when independent physician practices get swallowed up by a hospital or bought out by another entity just to survive, the cost of care can increase, creating ripple effects on our economy.

This kind of rapid consolidation is rampant in our healthcare system, partly because of payment incentives like those in Medicare.

“Our practice is already shutting its clinic doors as we instead focus on being a purely hospital-based practice due to already meager reimbursement,” another worried Texas physician shared with TMA.

“We simply cannot afford the overhead. Ongoing cuts to [Medicare] physician reimbursement not only hurt us — the physicians trying to provide the best quality care to our patients — but it ultimately hurts the patients and their loved ones suffering from life-altering conditions.”

“I barely scrape through making payrolls every pay period. Any more [Medicare] reimbursement [cuts are] going to put me and thousands of physicians like me underwater and force us to shut down or join [a private] equity company or [insurer-owned] clinics who put their wallets ahead of patient care,” said another frustrated physician.

We should be preserving independent medicine and patient choice — not undermining it. It’s time for Congress to address the root of the problem.

Solutions

The first simple step physicians and other healthcare professionals can take is to advocate for Congress to enact laws directed at paying physicians fairly for services provided to Medicare patients.

At a minimum, that entails pay that keeps pace with inflation. Like other industries’ labor costs are tied to the Consumer Price Index (CPI).

Medicare physician payments should at least be tied to a similar physician practice cost inflation measure, the Medicare Economic Index (MEI).

Several physician members of Congress are leading the charge on such a reform with a bipartisan House bill that behooves support: H.R. 2474, the Strengthening Medicare for Patients and Providers Act.

The legislation’s centerpiece is an annual, inflation-based Medicare physician payment update based on the full MEI.

Our current predicament is tied to the fact that Medicare physician payments haven’t even come close to keeping up with inflation over more than 20 years.

Since 2001, Medicare physician payments have lagged 26% behind inflation while hospital and other health industry payments have kept pace, according to the American Medical Association. Over the same period, the CPI for physician services in U.S. cities increased by 65%.

Just think about that: What would you say if you worked more than 20 years with no raise and pay cuts to boot? I know what my colleagues across Texas are saying:

“If [another cut is] enacted, our [Medicare] reimbursement rate will be lower than what we received in 2012,” one physician calculated.

Another said, “My Medicare reimbursement, factoring for inflation, is less than half of what it was in 1998.”

The frustration and the effect of Medicare payment cuts on physician practice viability are real. Likewise, access to care concerns for Medicare patients is therefore very real, too.

Don’t let a broken Medicare system break the backbone of the healthcare system for our most vulnerable patients.

Rick W. Snyder II, MD, opens in a new tab or window is a cardiologist and president of the Texas Medical Association.

1. Congress and the President, particularly the Libertarians and the Republicans, both of which care more about federal government money than the health of Americans.
2. The American people have not questioned why the finances of the Monetarily Sovereign government take precedence over the finances of the monetarily non-sovereign public.

1. Education
2. Health
3. Shelter
4. The environment
5. Science
6. Energy
7. Elderly support

1. The Liars, who do the bidding of the very rich and/or
2. The Economically Ignorant, who were taught that federal finances are like personal finances and who haven’t been shown the facts.

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The Sole Purpose of Government Is to Improve and Protect the Lives of the People.

MONETARY SOVEREIGNTY