by Del Meyer

In our continuing debate on having the government take over healthcare, the current debate on Medicare is germane. Medicare, a government healthcare program for senior citizens over 65 and those that have been disabled for over two years, has outstripped all projections in costs. When President Johnson stated in 1965 that Seniors should be able to assure their healthcare for a dollar a month or $12 per year, he missed the actual premium by thousands of percents and projected costs by hundreds of percents. As incomes and expenses soar, those in the healthcare field are being asked to continue to reduce their expectations because reimbursements are decreasing. The legislative branch of government continues to buy votes by increasing benefits without regard for the government’s ability to take that much money away from citizens to pay for these benefits.

When I was in medical school, the physicians’ part of the healthcare dollar was nineteen cents. Today it is about fourteen cents and decreasing. Medicare reimbursement is expected to drop another 17% from 2002 to 2005. Many physicians are closing their practice to new Medicare patients. The director of the family medicine residency programs at the University of Colorado at Fort Collins states that many Medicare patients call the university clinic because, after 15 to 18 calls, they were unsuccessful in finding a physician.

The answer according to Ralph Nader in his recent book, CRASHING THE PARTY – How to Tell the Truth and Still Run for President, is universal healthcare coverage. The politicians say that is the answer to providing healthcare to all. However, in most countries with universal coverage, the waiting lists are so long that about the same percentage as our uninsured are not getting optimal health coverage. In one instance, the government set up a new program, got rid of the previous five year waiting list (which made the politicians feel better) and started a new waiting list. How can an integrated mind accept such duplicity? Nader feels that except for Russ Feingold, Jesse Jackson and Paul Wellstone, the Democratic Party has shifted far to the right.

Maybe we should just socialized the whole healthcare system, place doctors on a salary with government benefits, vie for the 10-hour, four-day week or 12-hour, three-day week like everyone else, and let the politicians take care of the sick people after hours and on weekends. That would probably cover about as many patients as the British National Health Service is doing at the present time.

* * * * *Doctors are not innocent in hiking up healthcare costs. This past weekend, I received a call from a patient that I couldn’t recall seeing recently. When I returned the call from my exchange, I asked him what his Saturday emergency was. We get a lot of inconsiderate patients these days who’ve been sick for a week or longer and wait until the weekend to obtain their healthcare. They are shielded from the market place and the laws of economics which cannot be avoided any more than the law of gravity. Why should one take time off from work when it doesn’t cost any more to be seen on Saturday? However, the average free standing “Doc in a Box” charges about one and one-half to two times what an office call for an established patient costs. The average emergency room charges between 10 and 20 times what an established patient costs in a doctor’s office. This additional money has to come out of increased taxes if we have universal healthcare coverage or out of increased premiums if it’s private health insurance. Either way it’s a waste of money. As Milton Friedman stated, no one spends someone else’s money as carefully as their own money.

However, in this case, the patient stated that although his cough began on Wednesday, it did not raise green sputum until last night. He had already called his doctor, who was signed out to another doctor, who told him to go to a “Doc in the Box.” So he called the “Doc in the Box” and was told that he best go to the emergency room. Since he did not feel bad, and has had bronchitis previously, he thought this would be excessive cost. He then remembered that his family physician had sent him to me for a pulmonary consultation about a year ago and thought I might be willing to stand in. So I called in a prescription for Keflex, an antibiotic with which he previously had success.

What are the cost implications? This patient was judicious in his use of the healthcare dollar. It was reasonable for him to try to shake his upper respiratory infection. When it became a roaring bronchitis with green pussy phlegm, treatment shouldn’t have to wait another two or three days. That’s why my chronic bronchitis patients have one treatment of antibiotics at home for just such emergencies. He did not trade a $75 office call for a $900 emergency room visit as the on-call doctor suggested. As physicians, we must be cautious with spending healthcare funds.

The caveat you must not miss. This patient did not have an HMO where he was shielded from all financial risks. He had a PPO and shared risk of healthcare expenses. Hence, he was a partner in trying to reduce healthcare costs.

If we had all patients share some small risk of their healthcare costs, like 20% in this case, the costs of medical care would again become reasonable.