We see daily updates that the national budget is cartoonishly exploding, and a huge part of that are Medicare expenditures. In failed efforts to rein in spending, we have seen DRG’s, coding updates in apparent perpetuity, “quality” measures, pay-for-performance shell games, delayed payments, audits, a “free-drugs-for-retiree-votes” program, and the ever-present threat of administrative fines and criminal prosecutions. And still the bills go up, in a system that was guaranteed to cause massive inflation that will not stop, spurred by increased longevity and unrestrained demand. Gramps and Granny will not allow any reform of this system, thereby functionally demanding that government, with increasing overhead mandates, force doctors to treat them for progressively less pay.
But hey, I’m a problem solver, a guy who wants to build the bridge to the mid-20th Century. How can we cut costs, hmmm…(hits forehead)…I got it!
Years ago, I proposed a national chain of Medicare-only clinics, funded and staffed entirely by government. Medicare recipients could only go to these clinics. The concept was that they would be well funded, clean, brightly lit, the staff well paid, see ONLY Medicare patients, and would not be able to see everyone that wanted to get in. Like Medicare, it was built not on the ability to care for everyone, but on the appearance of doing so. So now, Phase Two.
We need primary care “providers” that have great quality (whenever they fund the studies), grrreat patient satisfaction scores (which are completely objective, and oh so valuable), who don’t have a lot of delay in largely unnecessary training, so less debt, who will work for a fraction of passé physicians. In fact it was the greedy doctors according to far too many senior voters and their politicians, who have been screwing over the Baby Boo-, uh, I mean the “Greatest” generation for years! And anyway it’s just primary care, so the cheery supervising Doctor of Nursing can just review all those referrals from her subordinate NP’s, and make the referrals to the proper specialists, as needed, after review and resubmission, if all conservative primary measures have been tried and failed. Heck, Aunt Pearline went through menopause during disco. She needs a couple rounds of antibiotics for that spotting before we go worrying about a lot of expensive GYN exams that will count against her primary provider’s resource efficiency score. And if those cramps get bad in the interim six months and her state is cracking down on opioids, it probably has legal medical pot to help out.
Why you ask, am I making this asinine suggestion? CMS has gone a long way toward creating a shortage of primary care via idiotic and wasteful mandates designed to delay or negate payments for care rendered, and still they are running out of money. Society in effect, through its elected bureaucrats told actual doctors they were not wanted to provide primary care. This helped fund the rise of the militant NP’s who are now trying to supplant primary physicians. Maybe we should practice a little jiu-jitsu and give them what they want. Let the NP’s take over all primary care for the retirees and let the government see how well that will really work. Let the Medicare beneficiaries see what they want to pay for. Sure, it will screw a hell of a lot of decent physicians who can’t escape to DPC, but it’s really just advancing the “cheaper-is-quality” timetable a little faster. And if a few seniors get grumpy along the way, they can take solace knowing it will be cheaper, and Big NP will guarantee quality and satisfaction numbers to cover their government paymasters. IN the long run none of this will stop rising Medicare budgets, but it will look like we’re slowing them down.
And like the sign says, free smoothies.