In case you didn’t watch the first Presidential debate, Barack Obama has a grandmother. Me too! I also have a grandfather. He will be 100 years old one week from today. For 35 years, he has been receiving Medicare. If I roughly estimate yearly Medicare spending per enrollee, Grandpa’s piece of the pie in recent years is about $8,000/year. I doubt he has used much of that allotment. He is an old, stubborn Polish guy who rarely goes to the doctor, hasn’t been hospitalized in many years and really just wants everyone to leave him alone with his ESPN. My 95 year old grandmother, Viola, is a different story. Her longevity combined with her frailty has cost us taxpayers much more.
My grandparents live independently and pay their co-payments without complaint. Like President Obama’s grandmother, my grandparents worked hard, paid into Social Security, saved money and deserve some assistance. But, during Viola’s last hospitalization, the second time she broke her neck, her doctor suggested a colonoscopy. This is where I draw the line. Just because we can test, doesn’t always mean we should. Most nonagenarians are of the mindset that they should do whatever doctors tell them to do. Given more accurate information, I believe many of them would opt out of costly diagnostic testing and treatments. Viola, after all, still vibrant and beautiful, prays each night she won’t wake in the morning. In medicine, as in life, it is often prudent to ask ourselves, “To what end?”
Five Quick Medicare Facts and the Dilemna
1. Medicare is a social insurance program, started in 1965, that guarantees health care to Americans over the age of 65, to many younger disabled people and to anyone with end stage renal failure.
2. The Parts – You will hear many references to the “parts” of Medicare over the next month. Part A refers to coverage for hospitalizations. Part B refers to outpatient care. Part C is called Medicare Advantage. It gives an enrollee the choice to have all his or her benefits provided by private insurance, with Medicare supplementing some of that cost. Part D is a prescription plan available to those eligible for Part A or Part B. Essentially, Medicare approves private insurance plans to take on this role. Members pay yearly premiums, co-payments, etc.
3. Cost – In 2011, the government spent about $524 billion on Medicare, 15% of the Federal Budget. Combine Medicare with Medicaid and Children’s Health Insurance, the total spent on healthcare was $732 billion.
4. Future – By 2020, it is estimated that the total spent on Medicare will be about $950 billion. This increase is due to inflation, the projected increase of the over 65 crowd and the rising rates of health care.
5. The Solution - I listened to the debate. I’ve read up on the proposals. Bottom line is “Uh Oh!” Neither plan seems to be able to overcome the fact that eventually, the Medicare fund will run dry. Obama wants to prolong the inevitable by cutting costs, Romney wants to find ways to change the current system, which will affect Americans 55 and younger. Click here for the simplest summary I could find. Anyway you slice it … more people + less money + higher costs = disaster.
This brings me back to my point. Doctors and patients alike have to start making smarter decisions about what tests and what treatments make sense. If a 95 year old woman has a colonoscopy and her doctor finds a cancerous tumor, what then? Should she then have a complete work up with biopsies, pet scans, etc.? Why? She wouldn’t survive surgery or chemotherapy. Is making a diagnosis important enough to put her through the discomfort and the country through the cost? I asked her. She doesn’t think so. The health care pendulum has swung at an odd angle. It started as a paternalistic health care system where the doctor always knew best and patients didn’t question. If it had swung in the other direction, we would have a system where patients were educated and made their own decisions. Somewhere in the middle would be perfect. Instead, we have a situation where health care decisions are determined by malpractice lawyers and insurance company accountants. Again, I don’t think either candidate has a perfect plan, but I do fear if government becomes more involved, we can kiss our health care options goodbye.
“I will never turn Medicare into a voucher. No American should ever have to spend their golden years at the mercy of insurance companies. They should retire with the care and dignity they have earned. ” — Barack Obama
“The American people I talk to don’t spend every moment thinking, ‘How can I tax my neighbor more than they’re being taxed?’ They say, ‘How can I get a good job? How can my kids get good jobs? How can seniors have a confidence in their future when they know that Social Security, Medicare and Medicaid are bankrupt?” — Mitt Romney