In the 1960s, when people needed assistive devices because of weakness, strokes, emphysema, obesity, arthritis and other ailments of aging, they went out and purchased what they needed. When Medicare was foisted on America, the seniors gradually realized, "Why should we purchase a cane when Medicare will pay for it?" So they waltzed over to their doctors and for a $20 office call obtained a prescription for a cane, which in those days was called a walking stick and sold for one or two dollars. The math is straightforward, spend $20 to save $2, but was not understood when the $20 and the $2 were both covered by Medicare. Of course, the $2 cane disappeared very quickly when the sale went from the corner drug and hardware store to Medical Supply Houses. Obviously, one could not put in a Medicare Claim for $2 when the paper work exceeded that. So the price of canes went up 500 percent to $10 and then 1000 percent to $20 to cover the billing and administrative costs of Medicare billing.

But the Medicare Gluttony didn't stop with canes. My father purchased his first wheelchair, as I recall, for about $10. When he had Medicare, the cost jumped immediately to about $50. A chair with a reclining back was about twice that. Government money was never seen as taxpayer's money. Just another 1000 percent increase in cost. No one seemed to care. My father predicted the government would eventually run out of money from such a Ponzi scheme. The news headlines seem to vindicate him.

The current fad is "why should my family have to push my wheelchair when Medicare pays for electric wheelchairs?" The reason no longer is "My left side is paralyzed and so the cane won't do it," but "your other patient in the waiting room does not look as sick as I am and, therefore, I should be allowed to have one also. Besides, they are such fun to drive. Maybe I can sell my car and make a few extra thousand dollars since Medicare is providing my transportation to the corner drug and market." To go from a $50 wheelchair to a $5000 first class electric wheelchair is a hundred fold increase in cost or a 10,000 percent increase in health care costs.

What's next? "Maybe one of these new small Minicars so I can travel to Nevada. It's so demanding to ride those Casino buses to Reno. Wears me out before I even get to the slots to gamble the half of the pension or social security checks I reserve for this. Aren't we supposed to enjoy our golden years?"

In this newsletter, we have seen people say we should reduce the exorbitant fees that doctors get from Medicare. They think that would solve the health care problem. However, none other than Ewe Reinhardt, professor at Princeton, remarked that we could cut doctors fees by 20 percent and it would have only a 2 percent effect on health care costs. Obviously eliminating doctors from the health care team entirely would not begin to balance the 1000 to 10,000 percent increase in costs that Medicare patient gluttony causes.

The only way to stem this gluttony and reduce health care costs is to have a significant deductible and a significant co-payment on every service. It also has to be a percentage so every patient will police his or her own health care costs. If the Medicare patient had to pay the 20 percent co-payment the initial law required and not be allowed to purchase any supplements, the cost of canes would have stopped at $5 or $10 rather than go to $50; the cost of wheelchairs would have stopped at $40 or $50. But insurance companies are still bragging about no co-payments in some policies and services. Thus, there are no breaks on generalized health care gluttony.

Human Greed Is Never Based On Medical Necessity.  

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This week, we saw a patient who was convalescing somewhat slower than he liked after being hospitalized with pneumonia. This was attributed to his advanced age of 98. The nurse at the "board and care" facility stated it was difficult supervising his self-care and he needed to be transferred to a higher level of care. According to Medicare Regulations, he had to be admitted to the hospital for three days and then sent to an available nursing facility. For the admission diagnosis, they used the previous diagnosis of bilateral pneumonia. This got everyone's attention and intravenous infusions were quickly started. By the time the hospitalist got the records put together, it was the third day and he was placed in a facility with a higher level of nursing care.

The nurse seemed somewhat embarrassed when asked about the need for these events and shrugged it off as Medicare regulations over which neither she nor the hospital had any control.

On reflection, the mechanism became more apparent and more illustrative. The diagnosis was needed to facilitate a major amount of nursing care. Patients with antibiotic infusions can command thousands of dollars more in charges over regular patients. They also require more consultations, immediate x-rays and follow-up x-rays. This higher level of care eliminates the personal physician from caring for this patient any longer since the nursing facilities have their own physicians. These physicians are more pliable to the home nursing program of the hospitals and are more easily motivated to readmit and utilize other hospital services. They can send patients to hospital emergency rooms knowing that a large number of unnecessary testing will be accomplished to increase revenue of the hospital.

Mandates always increase health care costs. What is not generally appreciated is that all mandates can be gamed for increased revenue at taxpayers' expense and taxpayers will never be aware of the gaming operation. We have to continue working towards eliminating all government mandates and restore health care to the patients as advised by their doctors. Then with a percentage co-payment, healthcare will again be in a Medical MarketPlace competitive environment, which will reduce health care costs astronomically.

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