Document ID: ./input/supremecourt_opinions/opinions/boundvolumes/529bv.pdf
Page Number: 762

529US3

Unit: $U55

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

687

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 provi-
sions 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 en-
sure 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 re-
ceiving 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 im-
posed on health care providers participating in Medicare.
Ante, at 672–675. The Court notes that health care provid-
ers 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-