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.”
;)
Dr. Alieta Eck, MD graduated from the Rutgers College of Pharmacy in NJ and the St. Louis School of Medicine in St. Louis, MO. She studied Internal Medicine at Robert Wood Johnson University Hospital in New Brunswick, NJ and has been in private practice with her husband, Dr. John Eck, MD in Piscataway, NJ since 1988. She has been involved in health care reform since residency and is convinced that the government is a poor provider of medical care. She testified before the Joint Economic Committee of the US Congress in 2004 about better ways to deliver health care in the United States. In 2003, she and her husband founded the Zarephath Health Center, a free clinic for the poor and uninsured that currently cares for 300-400 patients per month utilizing the donated services of volunteer physicians and nurses. Dr. Eck is a long time member of the Christian Medical Dental Association and in 2009 joined the board of the Association of American Physicians and Surgeons. In addition, she serves on the advisory board of Christian Care Medi-Share, a faith based medical cost sharing Ministry. She is a member of Zarephath Christian Church and she and her husband have five children, one in medical school in NJ.
Who can afford to pay CASH for Dr’s services?! Are you out of your tree?!!! They charge astronomical fees! It is simply unsustainable!
But then again so is Obamacare! The system we had was better than losing all our Dr’s though. More competition in the insurance industry and maybe less medical lobbying in government might help. There needs to be control on what can be charged for services to some degree…it’s just gotten out of hand. And so has medical malpractice lawsuits. There ought to be a stop to it too, or at least a cap or serious lack of incentive for suing. That might bring down malpractice insurance etc.
Covering everyone is NOT the answer!
@Julie, What we have now is a heavily manipulated market. A really Strong force (the government) takes money like crazy from the middle class to pay for the medical costs of those who are receiving Medicaid and Medicare. As pointed out in this article, there’s all kinds of frivolous tests and procedures going on that costs a lot of real money. This is causing severe increased demand on the system or on the market. According to economics, when there is increased demand, the prices will go up. That’s why just basic medical services cost so much for the rest of us. If we can ever get the government out of the way, then the prices will go down and all of us will be able to afford paying the basic stuff out of pocket.
My daughter fainted in the mall mother’s day while shopping on her own. A stranger called us from her phone. We arrived the same time as ems. My wife and I are both physicians. From her complaints and limited exam, I was sure she had a fractured skull. We were taken to the nearest hospital which has a good reputation. We are not on staff there. At the hospital, the ED doctor saw her and examined her, as did my wife and I before he came in. While waiting for the CT scan, we asked him when will the neurosurgeon come by to see her. The answer was he won’t. You will see a PA. The PA came around in short order and performed an examination that can only be described as infantile. My daughter was admitted to the ICU for observation for her fractured skull, subdural hematoma and counter coup contusion. She was there for 2 days until we elected to take her home and care for ourselves after realizing her attendings did not and will not see her. The PA’s did no further examinations either. We had no contact with any of the neurosurgical attendings until my wife raised her voice and made it clear they will never see another patient referral from our practice if someone does not take the time to answer some questions. Grudgingly, one of the attendings came by to hurriedly answer some questions; we realized for sure we were in the wrong place when even at this juncture he never took the oppurtunity to examin our daughter. Why did this happen? Why is this level of care tolerated? The answer is simple. We are in the redux phase of skimpy reimbursements where it is more cost effective to delegate care to lesser practitioners. This type of scenario will expand geometrically as it becomes impossible to earn a respectable living meeting, examining and speaking with your patients. Even complex procedures will be abandoned to technicians in the operating room when the reimbursement fails to support the innovation and sagacity that is required. Why is that nobody takes Medicaid in the office of respected, qualified doctors; only clinics with governement cover? the answer is simple, in NY State, the same visit in a private office is $12 where is is $168 in the government sanctioned clinic.
Thankfully my daughter is ok now. And she did have a work up for vertigo, arrythmia and hypoglycemia, etc that will be paid for via our medical savings account. If we tip past our deductible, we will be covered. We are happy with that arrangement as that is what it is for.
I think you made some great points Dr. Eck. Paying cash for basic maintenance is a great idea! If the whole system gets revamped and the free market is allowed to work we would all see costs for medical services decrease. If restructuring happens, doctors would be forced to compete for that business and would, out of necessity, be forced to keep their costs in line with acceptable standards created by the competition.
People in this country need to seriously stand up for themselves and stop expecting handouts! Our whole system/culture would balance itself out on its own if the government would simply stop giving away the farm…
So how is it that every other civilised country in the world has no problem making it work?
Obama is doing everything in his power to carry out his instructions to weaken the US in order to take us over. He is neglecting the Gulf Coast and the the immigration problems because He thinks these are two things that will weaken us a little more. The same with this rediculous healthcare plan. Then , Wham! we are in a socialist mess that will cause us our precious freedoms and way of life. The ladies of my church have started a prayer group just to pray for our country and the many problems caused by these people who have ended up governing our country. Don’t critisize me until you have tried it. We need to stand up and be heard and start honorning our God in Heaven!!
I have paid into medicare from the inception of it. I retired, had an Advantage program that was affordable and never included a “gym” or vision or dental care. The was eliminated in this bill so I took out a medicare gap plan with Blue Shield at twice what I had been paying. Yesterday I received a letter from them stating that effective August 1, my payments would go up approximately 10%. Today I called to find out the exact amount since it is automatically deducted from my bank. I am not sure where they learned math but my payment is gong from $130 to $169. That is not 10% and now places me in the position it being unaffordable if I want to continue to pay my utilities and rent. Now I am being told that I cannot terminate the policy nor can I change it until my birth month which is next spring. Maybe they should have read the bill.
As a benefits consultant and risk manager, I’ve been aware of these situations for a very long time. Every surgeon I’ve ever known has said that before performing surgery it is essential to first, stop the bleeding, and second, to stabilize the patient.
What Congress is doing is tantemount to performing a heart transplant while the patient is uncontrollably hemmorhaging.
The problem is that the entire system is run by and for the benefit of the attorneys lobby. (Why do you think Congress is comprised primarily of attorneys?) Attorneys should provide guidance on the law, not write the law.
When one considers every major piece of ‘benefit’ legislation created over the past 40 years and then weighs the benefits provided against the actual costs of compliance and administration of the legislation, the results are dismally deficient.
In actuality, one cannot help but to conclude that whether its ERISA, COBRA, TAMRA, TEFRA, HIPAA, etc… the primary objective is solely to create new fields of law for attorneys to specialize in to suck money from the private sector.
You’re right Quentin! It benefits lawyers because so many politicians ARE lawyers, so they write the rules to benefit their own. If they wanted to do ANYTHING about cost, tort reform would have been addressed.
The simple truth is that government can NOT control costs, nor is it their job to do so. It’s the government’s job to remove obstacles so that market forces can work.
Right now the medical billing game, where one rates is billed, and a rate that is often 80% to 90% below that is accepted. This practically ensures the ongoing need for third party payers to “re-price” bills.
The only way to have an effective, sustainable, affordable system, is to allow physicians to set their OWN prices, then let patients chose their own physician, based on their own criteria, be that quality, experience, training, or cost. Then the patient needs enough “skin in the game”, to be a consumer.
That’s the model at http://www.MediBid.com and it works.
100 years ago, maybe 150? we had no insurance…we didnt even have the mutual benefit societies that turned into insurance companies…I’m sure you’ve all heard the stories about doctors being paid in chickens, or pigs, or something similar. There’s indeed some truth to that. With technology advancines of the last 100 years, even the poor can afford color tvs, radios, cars, computers, (maybe not the BEST of these but still can afford them – being in southern California – ive had the chance to ATTEMPT to help hispanic immigrants (among many others) at starbucks with their laptops -but had difficulty many times because they have computers before they learn english) – it seems that the only technology to go UP in cost, beyond the reach of many people – is medical technology. Why is that? i think it has to do with insurance insulating people from the cost…..
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Ben,
You need to get more and READ. There is NO country where socialized medicine has not bankrupt the country or they must severely RATION health care. Stop drinking the cool-aid.