Jeffrey Singer is a general surgeon practicing in the Phoenix, Arizona area and a scholar at the Cato Institute, where he works on health policy studies. He appeared on The Bob Zadek Show across multiple episodes, discussing the effects of government healthcare intervention on physicians and patients.
Medical coding and price controls
In a 2013 episode, Singer described how Medicare’s coding system, created in the early 1980s, required physicians to submit bills using codes designed by the American Medical Association. He said the AMA lobbied Congress for and received a monopoly on the coding system, and that a significant portion of the organization’s income comes from developing those codes rather than from membership dues. Singer explained that physicians had to describe services based on available codes even when a code did not accurately describe a patient’s problem or the service rendered.
Singer told host Bob Zadek that Medicare instituted price controls in the mid-1980s during the Reagan administration, with a commission deciding what each procedure code was worth. He noted that a surgeon with the best record in the state and one performing an operation for the first time receive the same payment for the same code. Singer contrasted this with law, where Zadek said attorneys set their own hourly rates and are tested against the market daily. Singer added that under Medicare rules he could not reduce his fee for a patient with limited income because doing so would be considered discriminatory—he could not charge less to an 80-year-old widow living on a fixed income.
Singer described how physicians hired consulting groups and certified coding specialists to maximize reimbursement, and how the need to record a diagnosis to get paid could distort epidemiological data. He gave the example of a patient who comes in with a suspected breast mass, is found to have no mass, but must be given a diagnosis code such as breast pain in order to be compensated for a normal exam. He called the acquiescence to the coding system the beginning of what he argued was a cancer affecting medical professionalism.
The IPAB
In the same episode, Zadek called the Independent Payment Advisory Board the scariest element of Obamacare. Singer explained that the board of 15 individuals appointed by the President would review evidence and make recommendations to Medicare, with insurance companies following Medicare’s lead. He said the board would ration care through payment—advising Medicare to drop payment for services deemed not cost-effective, such as a total hip operation in someone over 70 or dialysis for someone over 65, which he said is denied to people in England. Singer noted the IPAB was being challenged on constitutional grounds because Congress cannot overrule its decisions and it is not subject to judicial or congressional review. Zadek added that the statute said a future Congress could not eliminate the board except during a three-month period in 2017. Singer said the rationale was to remove political pressures by making it independent of any review, comparing its finality to the Grand Inquisitor.
Zadek closed by saying doctors were increasingly becoming employees of hospitals penalized unless they followed guidelines and met benchmarks, and that more doctors were retiring early. Singer said doctors were “going Galt already,” and predicted the Supreme Court would not prevent people from using their own means to seek healthcare or penalize those providing it.
Free market and the corporate income tax
A 2014 episode featured a different guest, David, discussing the free market and the environment. In closing remarks, Zadek quoted the 17th-century French administrator Jean-Baptiste Colbert: “The art of taxation consists in so much plucking the goose as to obtain the largest possible amount of feathers with the smallest possible amount of hissing.” Zadek used the quote to explain why the corporate income tax has survived—because no one knows exactly who pays it. He announced that Jeffrey Singer would be his guest the following Sunday, describing him as a practicing physician who knows Obamacare from the inside out.
COVID-19 and medical advice
In a 2021 episode, Zadek introduced Singer as a practicing general surgeon in the Phoenix area and a Cato scholar who had written and spoken extensively on COVID-19. Singer said he had spent a great deal of time studying the matter as both a practicing physician and a senior fellow at the Cato Institute dealing with health policy studies. Zadek said that for the past year, medical advice about the pandemic had come almost exclusively from politicians rather than physicians, and asked Singer to assess the quality of that advice. The excerpt of Singer’s response is cut off at the point where he begins to answer.
Across episodes
The excerpts show Singer’s critique of government healthcare intervention recurring across 2013 and 2021, but the later episode’s substantive discussion is truncated, so no development in his argument can be traced between them. The 2014 episode mentions Singer only in Zadek’s closing announcement of a forthcoming appearance.
What the sources do not cover
The excerpts do not state Singer’s age, education, medical school, or the name of his practice. They do not give the outcome of any constitutional challenge to the IPAB, nor do they provide Singer’s substantive views on COVID-19 beyond the introduction. The 2021 episode’s discussion of vaccines and the “totalitarian principle” is not contained in the available excerpts.
Episodes
1 appearance, 2022–2022.
- Free Speech & the Scientific Method (2022) — Free speech medical science and government control. Cato Institute Senior Fellow