During the recent discussions about reducing our national debt some have mentioned Medicare and Medicaid as sources of future fiscal concerns. Baby boomers, people born between January 1, 1946 and December 31, 1964, are beginning to turn 65 at a rapid rate. The government estimates that 10,000 people are joining the Medicare rolls every day. Medicaid, a medical program for low income Americans, will be gaining 30,000 recipients in the next few years when the medical reform signed into law goes into full effect.
Medicare is funded by payroll deductions made by employers and their employees. When eligible because of age or disability, recipients pay about $115 a month for medical coverage. Companies paying for their employees’ private health care coverage costs spend about $1200 a month or ten times the Medicare contribution. This disparity is unsustainable. The accumulated funding for this program is down to a few hundred billion dollars and the current ratio is down to three workers for every retiree, not enough to make up for the cost shortfall.
What can be done?
First we must find where the major costs are. Almost half of Medicare and Medicaid costs are in end-of-life care. This includes nursing homes which can easily cost $100,000 a year; expensive surgery to extend life a little; and prosthetic costs for everything from knee or hip replacement to new dentures and dialysis for those not eligible for transplants as the biggest source of cost. The fact is that we are living much longer and using science to stay alive as long as possible as though in some kind of longevity competition.
We will have to make some moral decisions about our final days. Do we want to exhaust all remedies to prolong our lives no matter how painful or costly? Is quantity more important than quality? I suggest that we must consider quality over quantity and think in terms of costs and benefits.
If we are offered an optional surgery that will cost more than $100,000 while costing us only $20, should we consider its cost? It’s not our money. I say, yes, we should consider the cost as though we were paying for it ourselves. But do we?
In the new economy, we are being asked to make sacrifices for the greater good. Here is a good kind of sacrifice. Let us be willing to call it a day when our time comes and not accept expensive means to artificially extend our lives.
Since much of health care costs are hospitals and nursing homes, we must ensure that they are run as efficiently and effectively as possible.
Then there is the cost of medical doctors and specialists.
Medical doctors must first go through years of education. Undergraduate pre-med student spend at least three years taking chemistry, physics, biology and calculus, exclusively. They take no philosophy, psychology, humanities or literature courses. They are not encouraged to read novels. They are less well rounded than the average liberal arts major. This could contribute to an alienation from the full human experience.
If they study hard and focus primarily on their studies and on getting great grades, they can get into a medical school. They spend four years studying more about the science and math of the human body. They then spend two years interning at a hospital followed by two to four years as a resident learning their specialty - internal medicine, heart surgery, oncology, etc.
By the time a doctor is ready to set up a private practice or join one, s/he is about 32 years old. If the new doctor is not from a wealthy family, and many are, then there is a loan worth in the six figures to begin paying off. The doctor must get insurance in the event that some ungrateful patient and crafty lawyer conspire to make money of this doctor’s hard work. The doctor must earn money, real money and now.
Today there is a concern that doctors who are trained as primary care physicians cannot make enough money to pay off their loans, pay their insurance and live in a lifestyle appropriate to their rank and status. What will we do if doctors decide on more lucrative specialties? Who will do the job?
Doctors going into specialties seem to quickly forget everything they learned that does not bear directly to their specific area. A cardiologist doesn’t have to know anything about diabetes, or cancer or back problems or broken bones. An oncologist does not have to know much about heart function. Most specialists show very little interest in any other area.
Why is medical education so long, expensive, difficult and seemingly unnecessary while being so limited? Is this education meant to provide all the needed tools or is it a system to weed all but most elite within very narrow definitions? Could medical training be made both much shorter and more relevant? Instead of all that chemistry, physics and calculus, what about more courses in the social sciences and humanities? What about courses in management so doctors can manage their staffs as well as their personal business affairs?
And if primary care physicians don’t get paid enough, why not use nurse practitioners for almost all primary care? Can they be used as specialists too? Nurses are more hands-on than most doctors and rely more on the person’s body than on test results. It takes about three years to train a nurse practitioner and they cost much less than doctors.
Then there is individual responsibility and, perhaps, sacrifice. What would happen to healthcare costs if we all kept our weight under control, didn’t smoke cigarettes, exercised regularly, drank a minimum of alcohol and a lot of fresh water - became aware of and thereby controlled many of our unhealthy beliefs and practices? What would happen to health care costs if we could prevent and/or cure cancer, heart disease, and diabetes?
This is, the kind of thinking needed to bring down the cost of all American health care including Medicare and Medicaid.
Medicare is funded by payroll deductions made by employers and their employees. When eligible because of age or disability, recipients pay about $115 a month for medical coverage. Companies paying for their employees’ private health care coverage costs spend about $1200 a month or ten times the Medicare contribution. This disparity is unsustainable. The accumulated funding for this program is down to a few hundred billion dollars and the current ratio is down to three workers for every retiree, not enough to make up for the cost shortfall.
What can be done?
First we must find where the major costs are. Almost half of Medicare and Medicaid costs are in end-of-life care. This includes nursing homes which can easily cost $100,000 a year; expensive surgery to extend life a little; and prosthetic costs for everything from knee or hip replacement to new dentures and dialysis for those not eligible for transplants as the biggest source of cost. The fact is that we are living much longer and using science to stay alive as long as possible as though in some kind of longevity competition.
We will have to make some moral decisions about our final days. Do we want to exhaust all remedies to prolong our lives no matter how painful or costly? Is quantity more important than quality? I suggest that we must consider quality over quantity and think in terms of costs and benefits.
If we are offered an optional surgery that will cost more than $100,000 while costing us only $20, should we consider its cost? It’s not our money. I say, yes, we should consider the cost as though we were paying for it ourselves. But do we?
In the new economy, we are being asked to make sacrifices for the greater good. Here is a good kind of sacrifice. Let us be willing to call it a day when our time comes and not accept expensive means to artificially extend our lives.
Since much of health care costs are hospitals and nursing homes, we must ensure that they are run as efficiently and effectively as possible.
Then there is the cost of medical doctors and specialists.
Medical doctors must first go through years of education. Undergraduate pre-med student spend at least three years taking chemistry, physics, biology and calculus, exclusively. They take no philosophy, psychology, humanities or literature courses. They are not encouraged to read novels. They are less well rounded than the average liberal arts major. This could contribute to an alienation from the full human experience.
If they study hard and focus primarily on their studies and on getting great grades, they can get into a medical school. They spend four years studying more about the science and math of the human body. They then spend two years interning at a hospital followed by two to four years as a resident learning their specialty - internal medicine, heart surgery, oncology, etc.
By the time a doctor is ready to set up a private practice or join one, s/he is about 32 years old. If the new doctor is not from a wealthy family, and many are, then there is a loan worth in the six figures to begin paying off. The doctor must get insurance in the event that some ungrateful patient and crafty lawyer conspire to make money of this doctor’s hard work. The doctor must earn money, real money and now.
Today there is a concern that doctors who are trained as primary care physicians cannot make enough money to pay off their loans, pay their insurance and live in a lifestyle appropriate to their rank and status. What will we do if doctors decide on more lucrative specialties? Who will do the job?
Doctors going into specialties seem to quickly forget everything they learned that does not bear directly to their specific area. A cardiologist doesn’t have to know anything about diabetes, or cancer or back problems or broken bones. An oncologist does not have to know much about heart function. Most specialists show very little interest in any other area.
Why is medical education so long, expensive, difficult and seemingly unnecessary while being so limited? Is this education meant to provide all the needed tools or is it a system to weed all but most elite within very narrow definitions? Could medical training be made both much shorter and more relevant? Instead of all that chemistry, physics and calculus, what about more courses in the social sciences and humanities? What about courses in management so doctors can manage their staffs as well as their personal business affairs?
And if primary care physicians don’t get paid enough, why not use nurse practitioners for almost all primary care? Can they be used as specialists too? Nurses are more hands-on than most doctors and rely more on the person’s body than on test results. It takes about three years to train a nurse practitioner and they cost much less than doctors.
Then there is individual responsibility and, perhaps, sacrifice. What would happen to healthcare costs if we all kept our weight under control, didn’t smoke cigarettes, exercised regularly, drank a minimum of alcohol and a lot of fresh water - became aware of and thereby controlled many of our unhealthy beliefs and practices? What would happen to health care costs if we could prevent and/or cure cancer, heart disease, and diabetes?
This is, the kind of thinking needed to bring down the cost of all American health care including Medicare and Medicaid.
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