Down the Rabbit Hole on Medicare

After getting his proposed budget cuts to Medicare stuffed in March (cuts to doctors and hospitals, of course), Pres. Trump zoomed down to hit the Florida hustings to cheer on the continued survival of this beloved program.  He hit the premier gray ghetto in The Villages, promising to protect Medicare from “socialism,’ which is akin to preventing water from getting wet.  

Of course, no national politician has a chance now, without pandering to Baby Boomers still trying to live under some “greatest generation” umbrella, and modern history’s greatest-ever vote buy is the centerpiece of this mechanism.  Neither party or their leaders have any idea how to actually fix the underlying problem, which is the very existence of Medicare.  In the harsh glare of daylight reality, the average aging of the population, coupled with the ever-increasing Medicare budget, welded to an unwieldly, enlarging bureaucratic burden, all against the backdrop of a $22 trillion debt run up by people who think they had a right to run it up, means this is an accelerating disaster.  Until such time as the nation realistically accepts radical, and I mean drastic reforms to this mess, we will remain on the path toward – paradoxically – Medicare For All.  This is not an endorsement, just the political reality, as more in need will have more need, and will denounce doctors, particularly, as the source for their shortages.

So, if I gulp some hallucinogenic tea and follow Alice down the rabbit hole away from reality, what could we come up with?  Here’s one idea:  What if we determine to acknowledge Medicare as the dependency program that it is?  It expends far more money than it takes in, which negates the arguments well-off retirees so often make, that “they’ve paid into it all their life.”  Sorry, but if you are still costing the taxpayer more than you paid in, you are a government dependent.  Therefore, let’s treat dependents as such by protecting that on which they depend.  One way to do that would be to increase access, but how to do that if the government wants to cut reimbursements?  How could we make Medicare patients cheaper to see?

Congress could enact broad legislation that makes ANY Medicare providing physician or hospital IMMUNE to medical malpractice prosecution.  By sending all Medicare patients permanently to a strictly enforced tort-reform island, providing parties could dispense with 1) that portion of malpractice premiums associated with the elderly, and 2) stop all the defensive medicine currently practiced to prevent angry family members from bringing suit.  Why couldn’t this work to reduce costs, make more docs wiling to see the elderly, and move them through the hospital a bit quicker?  Before you accuse this approach of callousness call or it an excuse to mistreat patients, consider where we are now, and how neither party has any serious solution to these growing problems of doctor/hospital bed shortages, and rising costs.  This isn’t a cure-all, not even close, but it could start to frame things more honestly.  If it were to show good results, state governments could apply similar approaches to their Medicaid populations.

Naturally, the loathsome trial lawyers (sorry, redundant) and the malpractice insurance companies would not let this come without a long, bloody fight.  The lawyers will bleat and cry about harming patients, patient rights, and about losing their compassionate 40% of the take in nice cash-prize settlements.  The malpractice companies at least would transfer their revenues by jacking up premiums for non-Medicare patients.  And that’s where the magical tea starts to wear off, but hey, I’m trying.  Have you got a better idea?

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