Project 21 New Visions

Elaina F. George, MD

The Decline and Fall of Medicare


by Elaina F. George, MD (bio)

For those believing Medicare is sacred and needs to be saved, know there are disturbing truths conveniently swept under the rug in the name of politics.

Medicare now exists in name only.

Medicare has morphed into a bloated and virtually bankrupt system. People are fooled into thinking money taken out of paychecks waits to be spent on their health care needs.

In fact, money in Medicare's trust fund has been steadily raided for seemingly 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 it creates the Ponzi scheme that conditions largely define Medicare these days.

Addressing looming Medicare insolvency, however, begets a steady stream of politics as usual. Politicians kick the can down the road. The only difference is the rhetoric justifying behavior.

Democrats demonize conservatives during election cycles by bringing up the boogeyman of vouchers. But they rammed through the Affordable Care Act, removing over $700 billion to set up ObamaCare's infrastructure. This removes money directly from patient care ($517 billion from Part A's Medicare hospital trust fund and $247 billion from Part B's supplemental Medicare insurance trust fund).

Republicans fail to explain why the current system is not sustainable and do nothing to help fix the situation. They seem to hope they can use inactivity to their advantage.

While both sides fiddle, Medicare as we know it continues to burn. Any physician still taking it will tell you that Medicare "as we know it" is already gone. Neither side admits they were instrumental in causing the failure.

There's no denying that Medicare is going bankrupt and the government knows it. Policies and procedures already exist to limit care, limit benefits and foist more costs onto third parties such as AARP and private insurers through Medicare Advantage. Seniors pay more in co-payments for this short-term privilege. It can be argued that the ultimate goal is the entire country eventually paying for a "Medicare-for-all" scheme. This is the Trojan horse known as ObamaCare.

The facts must be separated from the fictions.

Fiction:  Seniors can keep their physician under ObamaCare.

Fact:   Physicians are opting out of Medicare. This increases the time it takes to see a physician and affects the quality of care by breaking long-term relationships between doctors and patients.

Fiction:  Quality of care will improve under ObamaCare.

Fact:    Beginning on October 1, hospitals will be fined for readmitting a patient for the same medical problem within 30 days after discharge. This ObamaCare-related pressure on hospitals will have unintended consequences as hospital financial interests are pitted against patient interests.

Patients with chronic diseases — such as heart disease and lung ailments, who relapse routinely — will be treated as outpatients for as long as possible to avoid fines. Then there are payments to hospitals based on "diagnostic-related group codes" 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 patients as quickly as possible on the other. Patients may be allowed to become sicker before they are admitted — making overall outcome more tenuous.

Fiction:  Patients and their families can still make health care decisions.

Fact:   Under ObamaCare, there are panels empowered to decide what constitutes standards of care (this is called "evidenced-based medicine"). These panels will decide how a disease is treated — from what medications are allowed to how long it should take for a patient to respond to treatment. The doctor and the patient will have virtually no say, and individualized care will likely be a thing of the past.

Since cost will become the overriding factor, palliative and hospice care will be encouraged for those with diseases deemed too expensive to treat or is a prognosis is poor.

The meme is that Medicare is the template for universal health care, but assertions this will provide better, more comprehensive and cheaper healthcare are not true. Instead, ObamaCare is centralized planning, where the good of the collective wins over the rights of individuals deemed too ignorant to make their own health care decisions.

The answer to health care is not more government intervention. It is less.

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Dr. Elaina George, a member of the national advisory council of the Project 21 black leadership network, is a board-certified otolaryngologist and host of a weekly talk radio show, "Medicine On Call," that explores health issues and the politics of medicine. Comments may be sent to [email protected].

Published by the National Center for Public Policy Research. Reprints permitted provided source is credited. New Visions Commentaries reflect the views of their author, and not necessarily those of Project 21, other Project 21 members, or the National Center for Public Policy Research, its board or staff.


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