The Truth About ‘Ending Medicare As We Know It’

Published June 28, 2012

If anyone proposes a substantial reform to Medicare, you can be sure demagogues will immediately wail that it will end “Medicare as we know it.”

It is also absolutely certain that Medicare as we know it will end. Politicians are just maneuvering to find ways to fix the blame on the other Party.

The end of “something as we know it” is not necessarily a bad thing. Try substituting “slavery” or “warfare” or “poverty” for the “something.”

Ending a “popular program that relieves people of their fears of medical bankruptcy” sounds really bad. Ending “socialized medicine for the elderly,” or “a Pacman-like program that will devour the whole economy,” or “death panels” might sound like a good idea.

Time to End the Denial

The current healthcare debate is aptly described by Congressman Paul Broun (R-GA) as the “four D’s:” deny, delay, destroy, and demonize. And the guilty parties are not all Democrats.

I have yet to hear any politician mention the unfunded liabilities of Medicare: the more than $50 trillion in promises that have been made with no way to pay for them. That’s Denial with a capital “D.” “Asking the rich to pay a little more,” or to pay “their fair share” wouldn’t be enough. Confiscating all the wealth in the nation wouldn’t be enough.

Delay, or “kicking the can down the road,” occurs predictably every time the increasingly draconian cut in physicians’ fees is due under the Clinton-Gingrich “sustained growth rate” (SGR) formula.

The “destroy” part started in 1966, with the cancellation of the private medical insurance policies held by a significant part of the elderly population. Today, independent doctors are being driven out of practice at a rapid rate, which can only accelerate with the costly compliance demands of the Affordable Care Act (ACA). Some sell out to hospitals; some just retire. Serious shortages are occurring already, even for very basic drugs such as anesthetics or anti-nausea medication, not to mention chemotherapy agents. Research and development will be enormously constrained by the medical device tax in the ACA.

Time for Needed Reform

Reformers like House Budget Chairman Paul Ryan (R-WI) are demonized in attack ads, for example, showing him pushing grandma over the cliff. Insurers are demonized for the rate increases that unavoidably result from expensive government mandates. Doctors are demonized for causing “waste, fraud, and abuse,” as bounty-hunting auditors or even armed SWAT teams invade their offices.

Europeans and Canadians worry about “patients dying in the streets, as in the United States,” if medicine is privatized. Where are those deaths? Where were they in 1965? There were none. The most likely cause of death in the streets is rioting, caused by unemployment, economic depression, and withdrawal of benefits that people have come to depend on.

With national health insurance, patients still die: on the waiting list, at home when denied treatment that is available in the United States, or in the corridor of the emergency department when there are no hospital beds.

Medicare beneficiaries will now die sooner in the United States also. Hospitals may punish physicians who transfer patients out to get better treatment elsewhere. Patients may get “terminal sedation” because Medicare punishes hospitals if patients are discharged and readmitted, but not if they die. Comparative effectiveness research may show that the “red pill or the blue pill” sometimes works almost as well as aggressive treatment, and at a fraction of the cost. Aggressive treatment may help only a minority of patients, so everybody gets the same ineffective pill.

Time to Face Facts

Since 1970, government spending on healthcare in the United States has increased 5,400 percent. This cannot be sustained. So we are faced with a choice.

We can continue the 4-D policy and keep inflating the healthcare balloon until it bursts and Medicare crashes and burns. Or we can allow people the freedom to choose a private alternative, in which case Medicare as we know it will end by attrition, as Americans find a better, voluntary way.

Jane M. Orient, M.D. ([email protected]) is executive director of the Association of American Physicians and Surgeons.