Modest Fees, Large Returns

When U.S. Senate investigators looked into the costs of Medicaid for the poor, they discovered payments to individual doctors running into five or six figures for a single year. Michigan's Medicaid program had paid $169,000 to Dr. Sanford Polansky, of Benton Harbor, for 1968. His case, along with the names of 80 other physicians who had collected more than $25,000 each, were in the records of Michigan Blue Shield, which serves as Medicaid's fiscal agent in the state.

Blue Shield published the information. The result, says Polansky, was "an enormous amount of crank-letter harassment" as well as "slanted and distorted unfair newspaper publicity." Added the doctor: "The harassment has grossly affected my wife's health and the well-being of my family to the point that my receipt of these moneys, though earned and deserved, is simply not worth the retaining." With that, he sent back a check for $169,000 to Blue Shield and invited the agency to re-audit his books, and to "honor only those invoices which are supported to your satisfaction by appropriate records." (Under Medicaid, the doctor who treats the medically indigent sends his bill to Medicaid's contract carrier--in this case, Blue Shield--which then reimburses him.)

Aiding the Poor. The Senate Finance Committee investigators did not allege overcharging by Polansky--but in drawing attention to his unusually large payments, they seemed to be implying that the doctor was bilking the Government. Actually, Polansky, no Cadillac-and-country-club doctor, has practiced for 21 years in the grubby Lake Michigan port of Benton Harbor. His dilapidated office is above a clothing store on West Main Street. Working with him are three full-time assistants.

As Polansky tells it--and local residents generally agree--he has become known as virtually the only doctor willing to treat the poor, especially Negroes. "Even before this Medicaid," said one patient, "Dr. Polansky would treat you even if you didn't have the money." Polansky has had to keep his office open seven days a week, and to work twelve-hour days except on Tuesdays and Saturdays, when he let himself off after nine hours. As for his charges, Blue Shield itself notes that they "are not only moderate, but are below average in many significant cases." One example: he charges only $90 for delivering a baby.

If Polansky saw patients 300 or more days a year, his daily gross averaged about $540. In a day, he could see 54 patients at an average fee of $10, and give each of them twelve to 15 minutes--which is just about what most patients get from most doctors.

Close Look. The Senate investigators who looked into Medicaid also drew attention to some huge payments under Medicare, the federal program for Americans over 65. In Houston, Dr. Michael E. DeBakey's surgery team collected $202,959, and Dr. Denton A. Cooley's, $193,124. Here again the fees do not appear exorbitant. In all, 1,050 operations were performed, with 50 or more surgeons taking part. Complicated open-heart techniques, including the implantation of artificial heart valves and pacemakers, were involved. Even so, the average cost to Medicare for each operation was roughly $380--a modest figure. All the money, said DeBakey, went to Baylor College of Medicine, which pays the surgeons' salaries.

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