Medicare Is Rotting into a Rationing System

With medical expenses going up, how could it possibly become anything else but a rationing system?

Reading the Washington Examiner story, “Medicare’s midlife crisis: Catastrophic finances pit doctors against patients,” I was reminded of all the promises that have been made about Medicare. These promises could not possibly be sustained. George W. Bush made promises in 2003 when he expanded Medicare. CNN reported,

High on the list of things not covered in the bill is a mechanism to stem rising prescription drug costs. Sen. Dianne Feinstein, D-California, who supported the bill, said the lapse was a “major weakness in this bill.”

“The theory is that private sector competition will drive down the cost of drugs,” Feinstein said last month upon the bill’s passage. “That may happen, or it may not happen. We need to watch that, and we will. I feel confident that the leadership will make changes if the cost containment is not kept.”

Cost containment. Basically the state gives away free money except it then must “contain” the spending. So you are taught to rely on diminishing care.

Now we find that Medicare is not doing well. According to the Washington Examiner,

This year, the government will spend $626 billion on the Medicare program as a whole — more than is spent on national defense. In fact, more is spent on Medicare than any government program other than Social Security. A combination of the aging of the population and rising healthcare costs will cause Medicare costs to explode even further in the coming decades.

There are about 77 million baby boomers in the U.S. By 2029, all of them will have turned 65, the age of Medicare eligibility. The boomers, combined with the disabled, will swell Medicare enrollment to over 88 million by 2040, a mere quarter century from now.

By that point Medicare will consume one out of every five dollars of the federal budget (minus interest payments on the debt) according to the Congressional Budget Office. All entitlements, including Medicare, Medicaid and Social Security, will consume almost 68 percent of the budget, leaving only one-third to pay for all other discretionary spending, including defense.

Topping it off, the federal deficit (including interest payments) will be about $1.8 trillion that year. To fill that gap without touching Medicare would require either severe, immediate, spending cuts; dramatic and economically unsustainable tax increases; or some undesirable combination of both. That means in reality, Congress will likely continue to make tweaks to Medicare aimed at restraining costs while avoiding the political blowback of any true reform that addresses the program’s underlying problems.

So patients are beset with an increasing number of irrational limitations. They are made to suffer with second-rate procedures and or medications.

The Washington Examiner story contains a great deal of information on what is going wrong with Medicare. Weirdly, while Medicare attempts to impose cost-saving rules, they sometimes end up increasing costs. Worse, they end up taking lives.

When Obamacare was passed, for example, it included a provision to cut back on hospital readmissions.

The Centers for Medicare and Medicaid Services defined a readmission as one that took place within 30 days of the initial admission. However, under CMS rules, a patient wasn’t initially admitted unless he was admitted as an inpatient. Obviously, this would give hospitals incentive to keep patients even longer under observation status.

To avoid this, CMS instituted the “two-midnight rule.” Under this rule Medicare would consider someone admitted to the hospital to be an inpatient when a “physician expects the beneficiary to require care that crosses two midnights and admits the beneficiary based upon that expectation.” That made it far more difficult for a hospital to keep a patient more than two days without admitting him or her as an inpatient. However, what if a patient needed inpatient care in a hospital but would not need to stay two days? In such instances, CMS had now placed its judgment over the judgment of physicians and patients.

New York City resident Frank Alfisi had no idea how this would impact him when he checked into St. Joseph’s hospital in mid-November 2013. Suffering from kidney failure, he needed dialysis that he usually received at a dialysis clinic. However, he missed an appointment due to the flu. The next day he woke up feeling so ill that he needed to go to the hospital to receive dialysis. But under Medicare’s rules, he couldn’t receive dialysis at a hospital unless he was an inpatient. Yet dialysis only takes a few hours and thus provides no justification for a physician to admit such a patient for two days in the hospital.

The doctors at St. Joseph’s ran a bunch of tests, trying to find something that would allow them to admit him as an inpatient, but their efforts were futile. Eventually, Frank’s condition worsened to the point that the doctors were able to justify admitting him as an inpatient. He received dialysis, but, because of the toxins that had built up in his body, the damage was done. He was now wheelchair bound, needed portable oxygen, and had lost much of his sight.

Frank’s quality of life had deteriorated to the point that he lost the will to live and decided to move into a hospice. He never made it, dying on Jan. 14, 2014, in the hospital.

So, while some people get killed by government to save money, transgenders get free mutilations. The Washington Examiner suggests the best way to reform the system will be to simply give people the cash and let them negotiate their own prices without setting up these rules for doctors and hospitals.

That would be fine as long as we taper it off and end the program. There is simply no way that government subsidies can do anything except distort medical care and eventually cause harm to the people we are supposed to be helping.