Medicare's victims

Last month marked fifty years since Congress created the Medicare program.  Medicare is often pointed to as proof that yes, Virginia, government can run a health care program that provides quality care to its beneficiaries. Even many of those who argue the program needs massive changes in order to avoid bankruptcy agree that the Medicare model is an effective way of guaranteeing health care to America's seniors.

But does Medicare really provide effective and  compassionate care? Dr. David Hogberg's, health care policy annalist for the National Center for Public Policy Research, new book, Medicare's Victims: How the U.S. Government's Largest Health Care Program Harms Patients and Impairs Physicians answers this question.

In case the title does not give it away, the answer is NO.

Dr. Hogberg also addressed this issue in an article for the Washington Examiner:

As Maryanne Wood sits on the passenger side of the car, she reaches forward and closes the air conditioning vent.

"I can't have that cold air blowing on my face," she says. "It can trigger serious pain."

Maryanne suffers from trigeminal neuralgia, a condition that causes excruciating pain in the face. At one point it was quite common for people suffering from it to take their own lives, earning the condition the moniker of "suicide disease."

"Winter, with the cold air and cold wind, largely puts me out of commission," Maryanne says. "There are days where you are literally just trying to survive and battle through the pain."

As a result, she is now one of the roughly 9-to-10 million disabled people on Medicare. And for Maryanne, that means she can't get the treatment she needs.

She has had surgery and takes medication for the condition, but those only temporarily stop the pain. A more promising treatment is laser therapy.

Medicare will pay for high-intensity laser therapy (sometimes called "hot laser") to treat trigeminal neuralgia. But surgery years earlier replaced the stapes bone in Maryanne's right ear with a metal prosthetic. Metal and a hot laser make for a dangerous mix.

One of Maryanne's doctors has suggested cold laser therapy. She would gladly try it, and while the Food and Drug Administration has approved cold laser therapy for the relief of pain, Medicare won't pay for it as it still considers the evidence insufficient to warrant covering it.

That leaves Maryanne with few options other than drugs like anticonvulsants and painkillers.

"Cold laser doesn't have the same risks as the drugs," Maryanne says, the frustration welling in her voice. "Addiction, slowed judgment, accidents — all of those things are side effects of drugs. But Medicare will pay for those."


his 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. But that will have consequences of its own.

As it has grown into one of the largest program's in the federal budget, Medicare has enabled government to assert unprecedented control over the doctor-patient relationship. The process that led to this level of intrusiveness happened gradually, with doctors and patients losing their freedom little by little. But, more and more, doctors and patients are finding that Medicare won't pay for treatments they want to try. Most worrisome, without serious reform, future cost pressures on Medicare will distort incentives and increasingly put doctors in conflict with their patients.


Talk to physicians today about Medicare, and it won't take long for them to complain about how it interferes with patient care.

"Medicare only pays for a breast MRI under certain conditions," says Juliette Madrigal-Dersch, a primary care physician in Texas. "Either a woman has to have had breast cancer or have the gene for breast cancer to get a breast MRI. So, if a patient has an abnormal mammogram but it's really hard to see what the problem is on the mammogram image, and I think that an MRI should be the next step, Medicare makes it very difficult to get it."

In other cases it can be difficult to get a patient out of the hospital. If a patient needs to be transferred to a skilled nursing facility for rehab, Medicare won't pay for it unless the patient has spent three days as an inpatient in the hospital.

"It's a silly rule," said Eric Novack, an orthopedic surgeon in Arizona.

He recalls a patient he recently treated who had broken her ankle.

"Fixing it should be an outpatient procedure, but she was a frail woman in her early 80s who lived by herself, so she had no one who could help her get around," he said. "She needed care in a skilled nursing facility, but the only way I could send her to one, without her having to foot the bill herself, was to keep her three days in the hospital."

Not only are such hospital stays wasteful, they are potentially harmful.

"I like to tell patients that hospitals are full of sick people, and if you don't have to be around them, you shouldn't be," Novack said. "The longer you are in the hospital, the more likely you are to have other issues."


his is where a government healthcare program like Medicare inevitably leads. As the program's costs exceed the means to pay for it, expenses must be reduced. Members of Congress will, of course, reduce Medicare's costs in ways that cause them the least amount of political trouble.

That means the sickest Medicare patients who will suffer the most because they are the most politically powerless. First, relatively few people get seriously ill each year, too few to have much impact on congressional elections. Second, because they are ill, they are in no condition to be organizing, protesting, getting media attention and the other things that can compel Congress to change Medicare policy. Finally, some of them are so ill that they won't be around much longer to cause Congress any headaches.

Read the whole article here.

And buy Dr. Hogberg's book here. Also remember to buy Campaign for Liberty Chairman Ron Paul's  new book Swords Into Plowshares. These books may make a great gift for your friends and family who still don't understand that a true supporter of liberty opposes both socialized medicine and war.

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