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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Pat Conrad MD

Pat Conrad is a full-time rural ER doc on the Florida Gulf Coast. After serving as a carrier naval flight officer, he graduated from the University of Florida College of Medicine, and the Tallahassee Family Medicine residency program. His commentary has appeared in Medical Economics and at AuthenticMedicine.com . Conrad’s work stresses individual freedom and autonomy as the crucial foundation for medical excellence, is wary of all collective solutions, and recognizes that the vast majority of poisonous snakebites are concurrent with alcohol consumption. 

  5 comments for “Down the Rabbit Hole on Medicare

  1. Steve O'
    October 13, 2019 at 8:40 am

    As long as people choose what feels good, but is not real, there is no hope of change.

  2. October 12, 2019 at 4:44 pm

    Instead of a buy-in, how about a buy-out as Dr Guastavino suggests? Just letting people out of Medicare Part A without seizing their Social Security would be a food first step. https://aapsonline.org/aaps-proposes-freedom-for-all-vs-medicare-for-all%ef%bb%bf/

    • Rochelle Odell
      October 19, 2019 at 5:01 pm

      May I ask how a Medicare beneficiary who opts out will receive needed care? Do they purchase a private insurance policy? We are already strapped financially, what would you recommend or offer Medicare beneficiaries? Or is it to be one where they go without medical care?

      A physician triggered my longtime battle with CRPS and worst part he never told me what he did, learned four years what he did that triggered the disease that within four years spread to all four extremities destroying my career in Nursing and forced me into permanent disability at 49. I never sued him but then he was out of state by then and the statute of limitations had passed. I have never sued any physician and in retrospect should have. We all have that perfect 20/20 hindsight.

      • October 21, 2019 at 12:26 am

        If you are on Medicare, you probably can’t purchase a private policy–government has seen to that.

        If you are not on Medicare, you can join a health-sharing ministry, at least Samaritan, but they don’t share pre-existings although people do make extra contributions to help these.

        Going without care is increasingly going to happen to Medicare beneficiaries as the program goes bankrupt and payment is denied. Doctors who are not opted out cannot by law offer privately paid care, and might even be in trouble for offering charity. You might be able to get care from an opted-out doctor, but would have to pay. Fees may be quite reasonable. Much more reasonable than “Medigap” insurance, which will not cover things that are supposedly covered by Medicare but are ruled unnecessary or are unavailable at Medicare-controlled price.

        Yes, people are financially strapped, especially the working stiffs whose taxes are paying the bills.

        People are getting pushed into hospice prematurely.

        Doctors of course will be blamed, but more and more of them will be gone. The bureaucrats ill still be there but won’t be able to help you .

  3. Thomas David Guastavino
    October 12, 2019 at 8:19 am

    Pay me back all of the Medicare and Social Security taxes that I and my employer have paid in over my 50 year working lifetime, with interest, and I would be happy to no longer be a “government dependent”.

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