As the President and Congress move closer toward passing the unpopular health care reform bill, the New York Times reported last month that “virtually every state is making or considering substantial cuts in Medicaid, even as Democrats push to add 15 million people to the rolls.” The Washington Post reported that “because the program is large and expensive, the spurt in Medicaid caseloads has produced far more damaging effects on state budgets than” food stamps or welfare benefits.” On the cost-cutting side, The Boston Globe editorialized that “Fear of intrusion in the doctor-patient relationship so inhibits insurers that they are shunning one of the most obvious ways to cut medical costs: Avoiding costly procedures when they are proven to do no good.” They cited a 2007 New England Journal of Medicine study which found that “doctors could save $5 billion a year by treating patients with chest pain with drugs rather than surgically inserted stents” which “has been largely ignored.” The Globe suggests that “the government should give the medical profession the impetus to determine the most effective treatments for a range of ailments by establishing committees to determine the best practices.”

On the personal front, I’ve marveled at the burgeoning age of my patients. A few days ago I saw a 90 year-old, and 84 year-old, and a 94 year-old in succession, and hardly a day goes by now where one of my octogenarians doesn’t present to the emergency room somewhere in atrial fibrillation, a rapid, irregular heart rhythm that is becoming epidemic. The ability to live long enough to glut the health care system is testimony to the success of out ability to manage, and modulate, the many chronic ailments we haven’t yet learned to cure.

While the Democrats argue that, when presented with pieces of the proposed health care legislation (such as immunity from denial of pre-existing conditions by the insurers, and portability of insurance), their constituents give universal approval. This fuels their arguments that the overwhelmingly negative reception by the voters to the legislation is simply a manifestation of the distortion of the facts promulgated by the Republicans. But I think the politicos (intentionally?) underestimate the collective wisdom of the people. The people know in their hearts you don’t get “something for nothing,” and the addition of millions to the rolls will add billions to the cost. They also know that health care reform is needed and inevitable, but the current proposal, as I’m hearing ad nauseam in the media, is “a dog that won’t hunt.”

The only way to get more “bang for the buck” is to change practice patterns, and increase competition. I’ve suggested ways this can be accomplished in prior posts. I welcome other innovative ideas.

Addendum: In my last post I noted that Medicare reimbursement was slated to be reduced by 21% in March 1st. In the interest of full disclosure, this cut has been placed on hold. It has not been repealed. The jury remains out on what the outcome will be.


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