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From
Fox News...
DR. MARC SIEGEL: How
I Would Fix Medicare
By Dr. Marc Siegel
Published April 14, 2011
President Obama made it clear during his
we-need-to-tighten-our-collective-belts speech on Wednesday that he
intends to ask for $480 billion cut from Medicare and Medicaid by 2023
with an approach that is sure to hamstring doctors and frustrate
patients by extending government control and restrictions (aka
rationing).
According to the president’s proposal, the Independent Medicare
Advisory Board, which will be formed in 2018, will play an expanded
roll in determining what are -- or are not -- essential medical
procedures and treatments.
If President Obama has his way, the federal government will also
decrease its spending on prescription drugs, increasing negotiating
leverage and the use of generics to lower costs (a process critics
aptly call “forced substitution”) while supposedly clamping down on
rampant fraud and abuse.
Anyone who’s been following the president’s rhetoric on health care
entitlements during the past two long years did not expect him to
suddenly change course in his speech on Wednesday and support Rep. Paul
Ryan’s plan to privatize Medicare beginning in 2021.
But Ryan’s ideas are far from pie-in-the-sky. In his budget proposal
Ryan expressed concern about some of the same ObamaCare provisions that
deeply worry me and other doctors.
The IPAB is only one of many government committees which are forming to
decide for Medicare (and the private insurances that will follow suit)
exactly which treatments are beneficial or cost effective and which
aren’t. Do you trust your government to decide which procedures and
medications and tests should be covered and which shouldn’t?
I don’t.
This determination will make the practice of medicine even more
difficult, especially when you consider that the elderly as a group
have more medical problems, need more diagnostic tests, and require
more treatments. Most of us who take care of these patients at a
fraction of what we used to receive for a visit are worried that with
all these growing restrictions, committees, and denials, we will soon
spend our entire day documenting and appealing until we can no longer
afford to continue seeing Medicare patients at all.
But it seems that ObamaCare has considered this eventuality too. The
new law will also be rolling out something called “Accountable Care
Organizations” which will destroy private practice even as it rewards
so-called “quality outcomes.”
Consider that quality under ObamaCare is just another euphemism for
streamlining treatments and services. Only large groups and hospitals
will be able to stay in business, hiring efficiency experts to preserve
their bottom line. Very sick patients with multiple problems may
receive mandatory coverage under the new law, but the ACOs will be wary
of sick and dying patients who interfere with their bonuses for keeping
people well.
Regulating Medicare as Obama envisions it may be a way to try to save
money, but it is also sure to make Medicare is much more unwieldy.
Attempts to cut fraud and abuse that are built into the law will be
largely ineffective without including incentives for practitioners to
police themselves.
I believe that medical panels comprised of doctors should be formed to
police physicians in our profession. Otherwise medical criminals will
find ways around the new restrictions just as they found ways around
the old ones. Doctors who order unnecessary tests and treatments for
profits will continue to find ways to do so.
Without tort reform (glaringly left out by the lawyers who gave us
ObamaCare), we doctors will continue to practice defensively, a culture
that leads to ever spiraling costs.
Rep. Paul Ryan has a different idea, though for me and many other
doctors, his plan to give seniors a lump sum to spend on private
insurance is not a cure-all either. Private insurers restrict us too,
and even if these denials are easier to appeal then with government-run
insurance, they also become more difficult as patients age and get
sicker.
I believe that raising the retirement age is a much more
practical and realistic first step to save Medicare money. Today’s 70
is yesterday’s 65. Since patients are living longer (over 70 million
baby boomers will enter the Medicare ranks over the next several years)
and remaining in better health, it also makes sense that even as people
work longer they can also wait longer to be added to the ranks of the
entitled.
I am all for privatizing Medicare up to a certain age, perhaps 75,
while beyond 75, when age-related illnesses really take hold, it makes
sense to find ways to limit the overuse problem without cutting down on
essential services.
Medicare (and Medicaid) definitely need to be drastically cut before
these programs go belly up. But these cuts must take place without
violating the physician’s Hippocratic Oath to first do no harm.
Marc Siegel M.D. is a professor of medicine and Medical Director of
Doctor Radio at NYU Langone Medical Center. He is a Fox News Medical
contributor and the author of the new book “The Inner Pulse: Unlocking
the Secret Code of Sickness and Health.”
Read it at Fox News
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