http://www.aapsonline.org/newsoftheday/001109Why the Government Cannot Control Medical Costs
Posted on June 28, 2010 by admin
By: Alieta Eck, MD
From the patients in my office we can learn why Medicare and Medicaid cannot control costs. Neither the President, the Congress, nor learned journals are telling these stories.
A spry, cheerful patient told me that she had fainted under the hair dryer in her beauty salon. The rescue squad rushed her to the emergency room of the nearest hospital. On the way, she was alert and speaking clearly with no weakness of her arms or legs. She told the rescuers that this had happened once before a few years ago.
All indications pointed to a simple fainting spell. Maybe she was dehydrated. The warmth from the hair dryer probably caused blood vessels to dilate and her blood pressure to drop.
Nevertheless, she spent three days in the hospital with EKG monitoring, and underwent a CT scan, an MRI, an EEG, and endless blood tests— all normal. Several specialists were called in for this “complicated” case. Finally, the patient insisted on going home even though some advised her to stay a little longer. She commented on how she probably would never have even been admitted had she not been covered by Medicare. And Medicare (working people and their as-yet-unborn grandchildren) will probably pay more than $20,000.
A television commercial states, “Last year, 9 out of 10 people got their Hoveround for little or no money.” A perfectly healthy appearing actress, sitting in her fancy scooter, folding her wash, says, “With Medicare and my insurance, I paid nothing out of pocket.” Those commercials ignore the fact that someone is paying for those expensive scooters— just not the actual users.
In a free clinic, one patient told me she preferred the brand name to the much lower cost generic. “Why?” I asked. “My friend told me the brand name is better.” Her prescriptions are covered by Medicaid, so all her medicines are paid for by someone else. I respectfully declined to write, “brand medically necessary,” and explained that although the medicine was free to her, the State of New Jersey is out of money and the generic will probably work just as well.
Are these patients or their physicians committing fraud? No. They are simply acting legally to enhance their own well-being, following the incentives set up by the unwieldy system. People with “coverage” do not care what costs they incur, and those who provide services benefit by providing more. As with the oil rig in the Gulf, there is a lot of pressure behind the leak. Adding more pressure —as with the Democrats’ idea of saving money by covering everybody—is not the answer. It can only make things worse.
We have in fact already tried it– in Massachusetts. The one-state version of ObamaCare functions only because of heavy federal subsidies. Massachusetts has tried to limit fees, and still the state is hemorrhaging cash. Massachusetts Medicaid went from $1 billion to $1.75 billion in 4 short years and the federal government—actually the taxpayers from the other 49 states— subsidized half that increase.
Will it take a bomb to stop the leak before we are smothered in oil or debt that our grandchildren will never be able to repay? What will be the result of the looming 21% cut in Medicare payments to physicians?
Doctors who have been accepting steadily diminishing payments to care for the elderly are increasingly bolting out of the system. Savvy Medicare recipients will continue to secure their free Hoverounds, but the weaker, more confused, sicker, and more vulnerable will find that fewer physicians will be able to care for them. Once the nation is bankrupt, hospitals have closed, and physicians have found alternate ways to earn a living, real medical needs will not be met. The best medical care in the world will simply cease to exist. Then all Americans, young and old, will feel the pain.
There is a better answer, pointed out by Rep. Ron Paul, M.D. (R-TX):
“We need a system in America where patients pay cash for basic services, and carry insurance only for serious illnesses and accidents. ‘Health maintenance’ is the responsibility of each of us individually. We cannot continue to collectivize the costs of healthcare and expect things to get better.”
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