For those who think Medicare is a sacred program that needs to be saved, there are some disturbing truths which are being conveniently swept under the rug in the name of politics. Medicare now exists in name only. Over the past decade it has morphed into a bloated, bankrupt system that has fooled seniors into thinking that the money they put into the system would be spent on their healthcare needs. In fact, the money that has been put into the Medicare trust fund has been steadily raided by Congress to use for everything except the health of seniors. Couple this with the fact that there are more people becoming eligible for Medicare while the labor force used to fund it is shrinking, and you have conditions that mix to form the perfect recipe for the Ponzi scheme that it has become.
The answer to the problem has been a steady course of politics as usual. Both parties have been complicit in kicking the can down the road. The only difference has been the rhetoric used to justify their behavior. On one hand, the Democrats have sought to demonize the Republicans during election cycles by bringing up the boogeyman of vouchers while enacting the Affordable Care Act which removes over 700 billion dollars in order to set up the infrastructure of Obamacare – which in reality is a process that will remove that money directly from patient care (517 billion dollars from part A which comes from the Medicare hospital trust fund, and 247 billion dollars from part B which comes from the supplemental Medicare insurance trust fund). On the other hand, the Republicans have failed to explain to the American people why the current system is not sustainable while doing nothing to help fix the situation in the hopes that they can use the lack of activity to their advantage to gain power in the next election cycle.
While both sides have been fiddling, Medicare as we know it continues to burn. Any physician that still takes Medicare will tell you that Medicare ‘as we know it’ is already gone. Neither side has had the guts to admit that they were instrumental in causing this failure to happen.
The truth is this….Medicare is going bankrupt and the government knows it. Policies and procedures have been put in place systematically to limit care, limit benefits, and foist more of the cost onto third parties such as AARP and private insurance companies through Medicare advantage, while making seniors pay more in co-payments for the privilege in the short term. It can be argued that the ultimate goal is to have the entire country eventually pay for it as the ‘Medicare-for-all’ scheme – which is wrapped in the Trojan horse known as Obamacare.
- Fiction: Seniors will be able to keep their physician under Obamacare
Fact: Physicians are opting out of Medicare, both increasing the time it takes to see a physician and breaking long term relationships between doctors and their patients affecting the quality of care.
- Fiction: The quality of care will improve
Fact: Under Obamacare (beginning October 1st), hospitals will be fined for readmitting a patient for the same medical problem within 30 days after discharge. This pressure on the hospital will have unintended consequences. It will pit the hospital’s financial interests against the patient’s interests. For example, patients with chronic diseases such as heart disease and chronic lung ailments who relapse routinely will be treated as outpatients for as long as possible before admission to avoid fines. Coupled with payments to hospitals that are based on diagnostic related group codes (DRGs) that pay for a certain illness based on the number of days a patient remains in the hospital, there will be a push to avoid inpatient admissions on the one hand, while discharging the patient as quickly as possible on the other. This is a recipe for patients to become more sick before they are admitted making their outcome more tenuous.
- Fiction: The patient and their family will make the healthcare decisions
Fact: Under Obamacare, there are panels empowered to decide what constitutes standards of care (evidenced based medicine). These panels will decide how a disease is treated and will encompass everything from what medications will be allowed to be used, to how long it should take for a patient to respond to treatment. The doctor and the patient will have no say and individualized care will be a thing of the past. Since cost will become the overriding factor – palliative care and hospice will be encouraged for those who have diseases which are deemed to be too expensive to treat, or the prognosis is poor.
The meme of Medicare as the template for universal healthcare as the direction which the country should move because it will provide better, more comprehensive and cheaper healthcare is not true. Welcome to the world of Obamacare were centralized planning applied to medicine places the good of the collective over the rights of the individual who is deemed to be too ignorant to make his or her own healthcare decisions. In short, the answer to healthcare is not more government intervention…it is less.