A doctor's vision for Medicare - LA Times

[cbayer]

Everyone knows the program is the big long-term problem in the federal budget. Here are three basic principles for what it should look like.

http://www.latimes.com/news/opinion/commentary/la-oe-welch-medicare-20111016,0,4689958.story


-snip-

My Medicare would be guided by three basic principles:

It should not bankrupt our children. Let's be clear: Medicare is rightly the central source of concern in the deficit debate. Its expenditures are totally out of control, and represent a huge income transfer to the elderly from their children. It's a program crying out for a budget.

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It should not waste money on low-yield medicine. I don't change my Volvo's oil every 1,500 miles, even though some mechanics might argue that it would be better for its engine. Nor do I buy new tires every 10,000 miles, even though doing so would arguably make my car safer. But in Medicare (as well as the rest of U.S. medical care) such low-yield interventions are routine.

-snip-

It should recognize the value of having time to talk with your doctor. The current system rewards physicians for doing things to patients, not for talking with them. Not surprisingly, we do too much. Too many clinic visits lead to another medication being started, another test being ordered and a referral to another physician. The end result is totally predictable: too many medicines, too much testing and too many cooks in the kitchen.

more at link

[PETRUS]

1. Why doesn't he confront the elephant in the room?

The principle reason projected future Medicare costs are so high is that our economic/political elites insist on supporting vast, numerous, for profit healthcare bureaucracies. Other modern nations (Western Europe, Japan, some Middle Eastern and South American countries) spend far less per capita on healthcare than the US and get better results. Our healthcare system is a classic example of market failure, and the public would be much better served by a national, single-payer system.

[saras]

2. Yep - he's suggesting that we quit caring for the elderly, not that we cut the bureaucratic costs

[BlueMTexpat]

3. Ab. So. Lute. Ly. Right. nt

[jwirr]

4. This is very superficial. No real suggestions. For instance what does

he mean by low-yield medicine? I am not a car. He does not appear to have thought this through other than wanting cuts to Medicare.

[COLGATE4]

5. I disagree. I think his point about 'having medical solutions in

search of a problem' is one of the critical areas in Medical care today, and one that drives the cost up for everyone. Is it really necessary to do a screening colonoscopy on an 87 year old? Is it really necessary to get your blood pressure to no higher than 120/80 by using a vast array of powerful medicines, regardless of your overall health? I think he's trying to go back to the type of medicine practiced by GP's before Health Insurance became the norm - treat the patient like a person, not like a number or a "case", and give treatment that is consistent with the patient's well-being, but not necessarily overdiagnosis and overtreating such is often the case today. It's not a complete solution, of course but it would go a long way to reducing unnecessary tests and diagnostic costs.

[jwirr]

6. I live in a small community and I do not see that happening here.

However, I do see doctors who are not doing a whole patient approach and treat only the main diagnosis and ignore the "little" things.

Two months ago I gave up on wanting to live. My doctor does an excellent job of treating my diabetes but he ignores everything else. So I have pain 24/7 every day. I am tired of hurting - so said "what the hell" and stopped following the diabetes rules. When I found myself in a real mess it dawned on me that I do have something to live for - nine great grandchildren. He is still ignoring the pain and the depression but I am working on them myself. All he would need to do is make a referral but he does not.

IMO by limiting doctors to what they can and cannot do it puts a patient in danger of being ignored.