Medical Costs
Daily Observer
“You
are brooding Simon.” I made a statement
of fact. His heavy-lidded eyes behind
the lenses of his spectacles resembled those of a sad beagle.
S.Q.
Lapius snorted. “Not brooding, Harry,
disconsolate.”
“What
piques you?”
“It
says here that the deductible for Medicare is jumping to $84 a year from $72.
“You
are not there yet. What’s to be sad
about?”
“I’ll
be there shortly, and by that time the initial payments will be nigh over a
hundred dollars. It is not only for
myself that I shudder, Harry, but for the millions of superannuated Americans
who will have to pick up the tab. After
all, the older you get the greater the chance that you will become ill, and
dependent on medical care.”
“But
you aren’t even sick. You haven’t a
symptom in the world.”
“The
fates are uncertain, Harry. I might even
have a tumor starting inside of me at this very moment. Anyway, it looks as though the government
assumed the medical obligations for the elderly without sufficient research,
somewhat glibly. After all, there’s no
limit to the care a sick person might require.
What happens to someone paralyzed, in a nursing home, slowly
deteriorating? First they have to go
into a hospital for a brief period of time before they even qualify for
payments to a skilled nursing home or an extended care unit. This alone distorts the hospital census and
puts people in the hospital who really should go directly to a nursing
home. Then after there has been
collusion on the part of all concerned to lie a little bit about the need for
hospitalization, the patient can be moved to a nursing home where his benefits
last for only about three months or so.
What happens after that?”
“They
go home to their families.”
“But
many families can’t provide the special care the patient needs. I see them all the time. They are brought to my offices in wheel
chairs, or sometimes by ambulance. Or,
believe it or not, Harry, I make house calls.
Ah, sickness doth make paupers of us all.”
“You
are waxing philosophic tonight.”
“You
must admit that we have a problem, Harry.
After all, as a person ages he grows increasingly dependent on those
around him, more and more of a burden, unless some lucky illness claims him
quickly. The government is already
feeling the pinch as evidenced by the jacked up initial deductible. But in addition, the government is misleading
about their promise to pay 80 per cent of ensuing medical costs.”
“How
can they get out of that?”
“It’s
a simple device, Harry. My patients, for
instance, complain that the government refunds them only 64 per cent of the fee
they pay me for an office visit. I was
puzzled and inquired into it. I called
the Medicare representative, and told them that one of their providers wanted
to speak to the chief administrator.”
“I’m
proud of you Simon. You, a mere provider,
got through to the chief?”
“A
false presumption, Harry. I only asked
to speak to the chief. I got instead
some untitled functionary, who, however low his estate, seemed reasonably
knowledgeable. I asked him why my
patients only received 64 per cent of the bill they paid me instead of the 80
per cent of the bill that the government promised to refund.”
“And
what did he say?” I prompted.
“He
said that they did indeed receive 80 per cent.
I told him the $6.40 on a ten-dollar bill was clearly not eighty per
cent. ‘Ah,’ he said to me, ‘that’s what the trouble is. Your bill is too high. It should only be $8. You see $6.40 is truly eighty per cent of
$8.’”
“And
what did you say to that?”
“Actually,
Harry, I was restrained, and didn’t say what I wanted to say. But I asked on what basis he had gratuitously
reduced my bill to $8. He told me the $8
was the average doctor’s fee for the neighborhood or geographical area or whatever
it is that we practice in. He said that
he had data from a survey that showed $8 to be the prevailing fee.”
“Well,
maybe you should reduce your fee then.”
“Sure,
and my rent, phone bill, salaries and cost of supplies as well. That would go over with a bang. But seriously, Harry, can you imagine that
situation? They decide autocratically
that all medical office visits should cost only $8. They don’t ask how long the visit is, or how
many patients the doctor sees in a day, be it 20 or 70, or what the condition
of the patient is.
I
guess if the government budget gets too large the government may decide I
should only charge $5 and refund the patients 80 per cent of that, or namely
$4. Certainly this is a classic case of
administrative chicanery, default on a solemn promise that a government has
made to its own citizens.”
“What
do you suggest?”
“Well,
at least tell the public the facts.
Admit honestly that the Medicare bill is more than the government wants
to pay, and lower the percentage return.
Don’t create a façade, and pretend that medical fees are what they are
not. The other thing they ought to do is
to leave to the judgment of the doctor what constitutes catastrophic and
compensable illness. If a doctor
testifies that a patient should spend the rest of his days in a nursing home,
that should be good enough. Or perhaps
ask for another opinion from a different doctor. Leave some room in the system for humane
consideration. Life and death can’t be
run by administrative codes and statutes.
Each individual must be treated as a separate case on its merits.”
“I
must say, Simon, you are very cranky about this matter.”
S.Q.
Lapius was not soothable. “Our
government is committing a breach of faith.
I don’t like to see our government behave in an undignified manner. It casts a bad reflection on Americans who
are, after all, a dignified people.”
“You
are taking it all too seriously, Simon.”
“Wait
till you grow older, Harry.”