Fischer v. United States, 529 U.S. 667, 21 (2000)

Page:   Index   Previous  13  14  15  16  17  18  19  20  21  22  23  24  25  26  27  Next

Cite as: 529 U. S. 667 (2000)

Thomas, J., dissenting

of such a result. Thus, although the Court purports to reject the Government's argument that "benefits" means "funds that originate in a federal assistance program," the Court, in practice, adopts it.

A

First, the Court describes Medicare's elaborate funding structure and notes that Medicare's reasonable cost recovery system allows recovery of certain capital costs and the costs of education and training. Ante, at 673-674. These provisions of Medicare do not establish that hospitals receive "benefits." To the contrary, the capital costs recoverable under those provisions of Medicare are the costs tied to the treatment of Medicare patients. See supra, at 684-685. In this sense, the cost provisions of Medicare expressly defeat any suggestion that they are meant to provide a "benefit" to the hospital. These provisions are not designed to provide financial assistance to the hospital; they are designed to ensure that Medicare beneficiaries receive quality medical care. And again, the Medicare program picks up only the portion of the costs attributable to the care of Medicare beneficiaries. 42 CFR §§ 413.50, 413.85 (1999). In fact, the Court does not grapple with the evidence that Medicare systematically under-compensates health care providers, evidence that would further undermine the notion that hospitals are receiving some form of financial assistance from the program. See Utz, Federalism in Health Care: Costs and Benefits, 28 Conn. L. Rev. 127, 138-139 (1995).

Second, the Court relies on the numerous obligations imposed on health care providers participating in Medicare. Ante, at 672-675. The Court notes that health care providers must satisfy licensing standards, provide a laundry list of particular health care services, and ensure an effective quality-assurance program. I assume, however, that the same could be said of most Government contractors. The defense contractor who agrees to build the military's equip-

687

Page:   Index   Previous  13  14  15  16  17  18  19  20  21  22  23  24  25  26  27  Next

Last modified: October 4, 2007