Beware: Cut Medicare Fees to Doctors and Watch the System Die

(Trying to cross post this at Huffington Post for this piece:
http://www.huffingtonpost.com/johnny-benjamin/beware-cut-medicare-fees_b_435283.html )
Sorry, nice try.

1. The projected cost of Medicare will bankrupt the United States.
Only if we do nothing to bend the curve and reduce unnecessary procedures and increase preventive care and care coordination. I suggest you read some Gawande and then come on back here. And "This American Life":
http://cmhmd.blogspot.com/2009/10/this-american-life-hc-reform-part-2.html

2. There remains tens of millions of US citizens that do not have adequate policies or means to pay for health care coverage.
Yet none of them are over 65.

3. The cost of adequate health care coverage for those citizens still fortunate enough to be able to pay is rising at an unsustainable rate.
See number 1.

4. Systemic waste remains.
See number 1 again.

5.Doctors are compelled to practice expensive defensive medicine due to fears of almost infinite liability and costs associated with litigation.

Really? When was the last time you saw a physician bankrupted by medical liability? That is why we have insurance. Patients, on the other hand are bankrupted routinely by health care costs.Defensive medicine varies inversely with the time you are willing to put in with the patient explaining what you are doing. The big problem with defensive medicine is that we are reimbursed well, in many cases to practice it, and rewarded very poorly for explaining why a patient does not need a CT scan or antibiotics or whatever.

I will acknowledge a frightening trend against science, however:

http://cmhmd.blogspot.com/2009/11/how-to-reform-broken-medical.html

Yes, we're all against fraud and we all SAY we are for universal access to prevent pain and suffering, but there are different views of that. For example, is going to a Remote Access Medical clinic good enough? Some would say that, yes, as long as there is a free clinic somewhere, that's good enough. I disagree.

At the risk of starting a food fight, I think if we totally revamped what Medicare pays for (quality, not quantity; counseling over procedures), we could absorb that 20% OVER THE LONG TERM without too much trouble. When specialists make 3 or more times what a PCP makes, something is wrong with the paymenty system (I'm an intensivist, BTW).

I'll stop there, and not take the bait on teachers. I hope you have some in your life and they read this!


Cheers
Read the Article at HuffingtonPost

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