An Interview with CMS as a Person

Where does an 800 pound Gorilla sit? Where it wants to sit.

Common Expression

Q: Many people think of you as a huge faceless bureaucracy – a government godzilla.

Do you mind if I address you as a person?

A: Not at all. It’s about time someone recognized me as a living, breathing person, rather than as an impersonal entity or as some kind of dominating force of government.

Q: I hope you don’t mind if I remind you many doctors think of you as an 800 pound health care gorilla, controlling and dictating everything they can and cannot do and what they are paid, even though you are far removed from the point of care.

A: I would prefer to be known as a paternalistic, compassionate sugar-daddy – bent on improving the health system with well-spent federal dollars and protecting people against free market predators and poachers, some of whom are physicians.

Q: So you regard yourself as a kind king and guardian of the health care jungle.

So you have tHis perception of yourself, as someone with a public protector with a passion for compassion?

A: Well, yes. After all, I cover 100 million Americans in three programs – Medicaid, Medicaid, and Children Health Insurance Program (CHIP), presumably the vulnerable, under-served, and uninsured among us.

The need for my services will only grow. Fifty million more Americans will qualify for these programs in the next five years.

And my policies essentially govern the health care coverage of 215 million other Americans, thereby protecting the other thow-thirds of the population.

Q: But there is a downside to your view of yourself. Follow your rules, or else, you seem to say. Otherwise, you will not be paid to deliver care or receive care. Obey the king of the health care jungle – the biggest health care payer and giver on the planet. The health care world must heed your instructions - or not be part of that world. That's pretty arbitrary. Is it not?

A: I carry a heavy burdent. Since 2010, I have been responsible for implementing ObamaCare, the biggest national health care program since Medicare, far bigger than Medicare/Medicaid/CHIP, since it covers everyone. The Office of the Budget estimates ObamaCare will cost over $2 trillion over the next 10 years.

Q: Who can argue with that projection? Since its 2010 passage, ObamaCare has already resulted in $1800 increases in premiums for families, rather than its promised $2500 decrease by 2016.

My question is: How big is Medicare/Medicaid/CHIP/ObamaCare going to get, and what will it cost the taxpayer?

A: I know not, but I am certainly big, and I’m getting bigger every day in every way. That is the curse of being a bureaucratic care giver. You have to spend big to get big results. I have a budget this year of $1 trillion, and, if history is any guide, that will grow, along with the current $17.6 trillion federal deficit, with debts of $900 billion for Medicare/Medicaid, $55,000 for each citizen, and $151,000 per taxpayer.

In 1965, when I was introduced to the health care world, it was projected I would only cost the U.S. $9 billion by 1990. That projection came before my little sister, Medicaid, the children of CHIP, and the budgetary beasts of burden of ObamaCare arrived.

Look how big I have become. By 2020, my collective costs may exceed $1.5 trillion. As Doctor Seuss would say, I'm figuring on biggering and biggering and biggering.

Q: Why do you cost so much?

A: That’s not an easy question to answer. But among other things, over the last 50 years, the life expectancy of women has increased seven years and 10 years for men. I regard myself as primarily responsible for the increased longevity and better health of Americans.

There’s all those new technologies, allowing organ transplants, long-term dialysis, and CT, MRI, and PET imaging, not to mention all those life-saving drugs. The list goes on and on. I take credit for financing them.

Then there’s the simple incentive that government promises of a “free lunch”, especially when you’re spending other people’s money, demand skyrockets. My job is to meet the demand.

Q: Some people claim U.S. has no health system. People don’t seem to acknowledge the hard reality – you are the system, and it's basically single payer in tht you set the fees.

A: How so?

Q: Look, I ask the questions here. Anyway, what I mean is this. You set the standards of how many doctors there will be, how much money for physician training you will provide, what doctors will be paid and for what , what their payment codes will be, who can and cannot practice, what much data doctors must collect, how they they must prescribe online, what electronic systems they must install in their offices, how they will transmit that data to you, what patients will be covered and who will receive subsidies, what federally improved plans they can enroll in, what doctors they can go to, who can run a hospital or any other health facility and who will own it, and what they can charge. Other health plans follow your lead.

A: When you pay the money, you set the fees , you dictate the choices, and you make the rules. You have to account for each dollar spent. You have to watch out for fraud, which is why I initiated a $210 million fraud protection programs. You have to control what doctors order because what they order accounts for 80% of health costs.

Q: What would happen if the costs of your policies cause health premiums and deductibles become unaffordable, bureaucratically unfathomable, and unacceptable to Americans.

A: That will never happen.

Q: Any closing comments?

A: Go to medicare.gov and healthcare.gov to appreciate the breath and magnitude of what I do and what I promise to do for the American people.