Medicare’s Right to Die?

Cars are just too expensive for seniors, proclaimed the politician when he unveiled his new plan. The bill passed, and so the government collected money from every worker’s paycheck to buy the cars, then paid the dealers about 20 percent of the market prices.
Soon every senior had a car through the government program cleverly called “AutoCare.” But there were some problems. First, the showrooms of some dealers were cleaned out as seniors clamored for luxury cars for the government’s bargain-basement payments. Some dealers were run out of business because they had to sell so many pricey cars at a loss.

It just got worse for everyone when cars became more expensive because seniors demanded better and more extravagant cars. When there was a shortage of cars, seniors tried to buy cars on their own with their own money. But the government said that was illegal, and threw the dealers in jail. Federal agents mobilized seniors to rat out dealers who told the government the car was blue, when really it was green-blue.

The final straw was the rebellion of the younger citizens when they found out they were paying for seniors’ new Broncos when they were still driving old Pintos.

Seem ridiculous? Just substitute Medicare for AutoCare, doctors for dealers and you get the picture.

When Medicare started in 1967, many people were initially pleased with it because the government obligated itself to pay for most medical spending for most Americans over age 65.

But the country responded to Medicare in the same way as our mythical citizens did to AutoCare. Many Medicare patients could now seek more highly trained specialists and better hospitals. But these services and facilities were also more expensive.

One reason demand escalated was because many patients used the system as designed. The grandmother of a friend of ours was a very frugal woman who rarely saw the doctor — until Medicare was created. Then, because Medicare covered one doctor visit every month, she saw her doctor every month thereafter. After all, frugality involves using resources to their utmost.

Soon Medicare spending projections were off by 1,000 percent. The planners had not adequately appreciated many factors, such as increased demand for more and higher quality services from patients, with resulting inflationary pressure on medical prices. If the AutoCare program had started in 1967, the average automobile would now have a list price of about $100,000.

When the politicians were called on to come up with more money for Medicare, they cried foul and looked for a scapegoat for their budgeting folly. Somebody or some group had to be found to take the blame. As there aren’t as many doctor-voters as there are Medicare-voters or even government-bureaucrat voters, the politicians turned up the heat on the doctors.

In 1996, Congress criminalized unintentional clerical billing errors made by Medicare providers. Many capable and honest doctors have been victimized by government prosecutors because of this flawed approach. Yes, many criminals have been caught, but at least as many honest doctors have been driven from practice, retired early, been financially ruined or even jailed because of “overzealous” prosecution.

Yet, Medicare invites fraud. Unlike credit card or other bills, the patient may never see what Medicare really pays or be unable to comprehend a hospital billing when a copy is presented. And, if government pays most all of the charges anyway, why bother trying to figure it out?

The current effort to ferret out fraud and abuse has had unintended consequences. For example, a number of surveys show about one-fourth of doctors are refusing to accept new Medicare patients. One shows that the leading reason is hassles or threats from the government. The amount of the physician fees was a distant fourth.

This survey demonstrates that medical care to Medicare patients is government-rationed by the hassle factor. If the government really wants to save money rather than prosecuting doctors, why not require the patient to endorse the Medicare check or even send the payment check and explanation straight to the patients. If the patients were to pay the doctor directly, fraud would be virtually eliminated.

Yet government is so intent on control that Medicare also makes it impossible for doctors to provide additional paid care to requesting patients or even free medical care under threat of criminal prosecution and jail time. In 1995, the Association of American Physicians and Surgeons marked the first “Medicare Patient Freedom Day” by treating patients for $1 cash, while refusing to file claims for reimbursement from taxpayers. The government responded by saying it was illegal not to file a claim for payment. Jane Orient, M.D., warns, “Doctors should refuse to be willing participants in this game of regulatory Russian roulette.”

Not to belabor the point, but we think a system is bizarre when it allocates one billion dollars to lawyers and investigators to search out and destroy fraud, while paying dimes on the dollar to the true providers of senior care. Might not the government be the entity that is guilty of the real fraud!

Thoughts on Medicare reform divide roughly into two camps, one believing that government should do as much as possible, and the other that government should do as little as possible.

Medicare patients should have greater freedom to choose their doctor. But the current bureaucratic system discourages many fine physicians who would rather be taking care of patients than spending time trying to comply with the enormously complicated and often undefined Medicare regulations.

When doctors spend an average of 500 hours — and some many more — per year dealing with Medicare, that’s a lot of time that would be better spent treating patients. Until doctors are freed of the regulatory burdens, patients are allowed the choice to electively pay more for additional health-care, and Congress removes the incentives to cheat the system, nothing much will change.

We also hope that the American flair for fairness will reassert itself. It’s unfair to ask poor young workers supporting a growing family (and perhaps even their own parents) to support those senior citizens who can afford care.

When asked why he robbed banks, Willie Sutton answered because that’s where the money is. While no one would dare accuse Medicare patients of robbery, that fact remains that Medicare is where the money is. As long as we think of Medicare as an unlimited entitlement, the question may not be how to fix Medicare, but can Medicare be fixed at all?

Now that Medicare has grown older and the baby boomers are coming of age maybe Medicare should take an early retirement. Perhaps Medicare should die!

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Michael Arnold Glueck, M.D., of Newport Beach, Calif., writes extensively on medical, legal, disability and mental health reform. Robert J. Cihak, M.D., of Aberdeen, Wash., is president of the Association of American Physicians and Surgeons. Both doctors are Harvard trained diagnostic radiologists. Collaborating as The Medicine Men, they write a weekly column for WorldNetDaily as well as numerous articles and editorials for newspapers, newsletters, magazines and journals nationally and internationally.