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Medical Care Dictated by “Code”

Government agencies spend a lot of time telling doctors and hospitals how to practice medicine.

Government agencies spend a lot of time telling doctors and hospitals how to practice medicine.

Written By Robert A. Eslinger D.O., H.M.D. |

The Federal government manipulated itself into a position where it is actually dictating the practice of medicine. It is using its payment system to control the types of medical treatment Americans get, leading to high medical costs and high mortality.

The “codes,” developed by the AMA, are known as the Physicians’ Current Procedural Terminology (CPT) system. The rationale behind using the codes is supposedly to ensure that Medicare (the government) only pays for medically necessary services for disease, disability, infirmity or impairment.

But, saving money doesn’t seem to be the actual reason for the codes. They are currently being used to give the government control over patient treatment protocols.

The CPT codes and International Classification of Disease (ICD) codes, which identify the illness or health problem the person is seeing the doctor for, are promulgated by the federal government and are the code numbers most physicians and hospitals must provide to the government or insurance companies to determine if the physician or hospital will get paid for tests on or treatment of patients. If you don’t follow government guidelines, you don’t get paid.

If the government doesn’t think a test or treatment is “indicated,” the Centers for Medicare and Medicaid (CMS) won’t pay for it, and the doctor and hospital might even be accused of committing a crime (fraud). Even if it saved your life!

Moreover, private insurance companies follow the government’s lead. When doctors or hospitals bill insurance companies, the first question they ask is “Does Medicare/Medicaid approve or pay for this?” If the government doesn’t recognize or pay for prescribed procedures and medicines, then the insurance companies won’t either.

Government agencies spend a lot of time telling doctors and hospitals how to practice medicine, which tests to order, which medications to use, and when patients must be sent home-in order to avoid being penalized for not following the rules. But nowhere is there anything that suggests that these agencies have the knowledge or training necessary to make the types of clinical decisions that doctors and hospitals must make every day. There is not a single study to prove that the U.S government does a better job of delivering healthcare than a doctor or hospital does.

In fact, there is plenty of proof to show that federal bureaucrats don’t do a good job of looking after your health. For instance, the FDA, which is (theoretically) responsible for monitoring the use of medications and food to assure the safety of the American public, can’t be bothered to investigate, even when health concerns are brought directly to its attention.

Late last year, the FDA determined that the drug Avastin, which has serious side effects, is not effective for treating breast cancer. Astonishingly, Medicare declared it will still pay for Avastin-at a cost of about $88,000.00 per year for each patient. This is because of the influence of lobbyists for particular financial interests (read drug/insurance companies!), which have very much power over these agencies. It has absolutely nothing to do with ensuring quality medical care.

Unfortunately, it seems that even more of this insanity is coming, not far down the road. That is why I do not take insurance.

1. Fleming, Richard, M.D. Codes that Kill. The New American. July, 2013.
2. CPT and ICD-10 Code (books published by the AMA)

For more info, contact Reno Integrative Medical Center at (775) 829-1009, or visit online at