As a long time enrollee in the Medicare program I have insights into the reason that Medicare is facing problems. It is not that the program is not well designed, but that it is abused. Until recently I had AARP Medigap insurance that cost me $180 a month, and covered all deductibles and co-payments so that in twenty years I have never paid a cent out of pocket except for that policy. As a survivor of a deceased disabled veteran I now have ChampVa which covers costs that were covered by the AARP policy. It also pays for 75% of my prescription costs.
At age sixty-six I had breast cancer and had radical surgery to stop it. I declined the very, very expensive Tamoxifen, not because of cost but because I didn't trust it to be a safe medication. I have a personal conviction to refuse any medication that has not been on the market for at least five years....in that time all of the deadly side-effects have been reported and that is how long it will take the FDA to recall it. It appears I was right as many women on this therapy have encountered uterine cancer, one of the reported side-effects. I have been fortunate to avoid a recurrence of the cancer...for 18 years. I had also refused to take estrogen therapy for menopausal symptoms, also a cancer causer. Medicare does not pay for prescription drugs, so that is not a cause of the problem, but Medicaid does, and I have seen in my own family that doctors prescribe name brand drugs when they could easily prescribe a generic....just a personal history that might be useful to consider. Here is the problem as I have experienced it.
Doctors and hospitals abuse the program and for whatever reason patients allow them to do this..they order tests that are done in their offices and cost a very lot of money and are paid for by either Medicare or Medicaid. A nurse at my doctor's office told me that I "needed" to have a bone scan. This is a very expensive test that detects osteoporosis, a condition of aging that for many centuries has not had a treatment, but now does. I had this scan about 8 years ago, and of course I do have the condition; it is not a disease it is a condition of aging. The treatment is a very expensive once a month, or now, once a year pill that reportedly not only prevents bone loss, but also reverses it. This medication has some very troubling side-effects so I have refused to take it. So, for what purpose would Ihave a bone-scan? To enrich the doctor. I am 84, of course I have osteoporosis...it is a function of aging. When I say I don't want the test, the nurse looks at me as if I have lost my mind: with pity. What percentage of people do you think refuse medical tests? It would be difficult to find out. Among the people in my age group (not many left) I have known, I have neve known a single person, of either sex who refused a medical test. This adds up to billions of dollars in costs to the program. Mammograms; that is indicated. That is one test, not very expensive, that I have.
I have never had more than three doctors: a primary care physician, basically a pill pusher and medical test purveyor, a gynocologist, and an eye doctor. I see two of them once a year, one of them three times a year. Frankly, it is too much bother to be going always to a doctor's appointment. But women I have known have as many as six doctors they routinely go to see, and often. It is like an insurance policy against disease, and from each they have a test that is routinely taken, and a medication. The tests are the biggest expense for Medicare...My husband was a disabled veteran of WWII, and had VA doctors. But when he had an urgent medical need he had to go to the local emergency room, and if necessary then be taken by medivan to the distant VA hospital. He observed that whenever he went to the emergency room at the local hospital the first thing they did was order a chest x-ray and blood tests. His problem was not related to his lungs so why a chest x-ray? Why extensive blood tests before a doctor had even seen him. The same reason my doctor wants me to have a bone scan: revenue. In the last couple of years of his life he had at least four chest x-rays. This cost Medicare, as he paid for Medicare Part B, which this year cost a little more than $100. a month.
I entered the hospital a few years ago because I was suffering from shortness of breath. They called a cardiologist who ordered a chemical stress test, of course a chest x-ray, an echocardiogram, and many blood tests. My heart and arteries were not involved in my breathing problems. The final diagnosis was bronchial asthma...and I was given two inhalers and sent home. Why didn't they rule this out first? No money in it.
Over the years I have seen many, many friends, made anxious by their doctors ordering tests and referring them to specialists, who have agreed to all manner of expensive tests and procedures. Would they have agreed if they were themselves paying for them? I very strongly doubt it. Medicare is too generous with its reimbursement for tests and procedures, doctors are too prone to order tests and procedures for unlikely illnesses, and Medicare is hostage to all of these. Insurance companies go too far in denying tests and procedures, and I am not suggesting that Medicare go that far, but there should be the same oversight of tests and procedures offered that you would exercise if you were paying yourself.....
Oh, and another thing: diabetics get one pair of free shoes a year. OK. It is important that diabetics wear well-fitting shoes, as an ulcer can lead to eventual amputation if left untreated. But shouldn't there be a means test for this? Shouldn't people who can afford to buy shoes pay for them? Just askin'. There is an industry built around this benefit: shoe companies that provide at a cost of about 300 dollars, plus the cost of the doctor "fitting them", shoes that could be easily purchased for half that. I have a pair of New Balance walking shoes that I paid 159. dollars for. They fit perfectly. I just bought a pair of Easy Spirit clogs for 79 dollars that also fit perfectly. Why does Medicare pay upward of 300 dollars for shoes? because they are provided by a Podiatrist who supposedly fits them to your foot configuration, and yet, they are just shoes; not custom built to your foot's paramenters, and usually the person fitting them is not the doctor, but a young woman who probably makes minimum wage.
This is turning into a rant, and it is because the prospect of having what was a valuable program for needed medical care has turned into a scam....a scam that may well cause it to be killed. I don't want it killed; I have children approaching the age when they will qualify for the program; I want it to be available for those who are very sick, who need surgery or chemotherapy, in short, I don't want to see it die by grift. Why are medical costs and so Medicare/Medicaid costs rising so high? Because no one is paying attention, and every year a new benefit is added. My mother died of colon cancer: it was well advanced by 1965 when Medicare was signed into law by LBJ; had she had access to a regular doctor who could have detected it early she would have lived longer. I do not want to see this program gutted by Republican zealots without conscious, but I do believe it should be reformed. President Obama has promised to do this; I trust him.