Why Primary Care Doctors Must Enter the Medicare Debate

The passage of Medicare in 1965 was a crucial boon to our country's elderly and heralded a new era of American health care provision. All of the initial fears of Medicare faded quickly; it was not socialized medicine, did not destroy the doctor-patient relationship, and did not dissuade people from becoming doctors. But like a white water river (such as this picture of my son on the upper Yough in Maryland, a class V haven), Medicare has tossed us down continuous rapids and trecherous rocks as the population ages, chronic illness and dementia take hold of more people, and the cost of medical care from hospital/technological/medication costs escalates. While thought leaders concoct band-aide approaches to repair Medicare, its ultimate philosophy--payment for aggressive care but not home-based palliative care--has not changed, preventing it from navigating the fast moving water on which it glides. Without the input of practicing primary care doctors, who really understand the needs of their elderly patinets and the deficiencies of what Medicare is offering them, our crucial national insurance will not survive its journey. It is going bankrupt, and it is letting down the people it is designed to serve. In my book I look at the history of Medicare, explore what we know about medical intervention in the elderly, discuss how Medicare's rules and payment structure do not facilitate rational and beneficial medical care for the elderly, examine the current reforms being instituted by Medicare and the ACA and why they do not address the problems, and then present ideas that my own 25 years of medical practice has taught me will help Medicare change course and successfully navigate the rapids for many decades to come. With my blog I will be inviting doctors and patients, politicians and pundits, to share their thoughts about how to repair our essential national health insurance. But I especially want it to be a forum for primary care doctors like myself. As Democrats cry foul every time changes are perceived to restrict care, as Republicans cry about death panels and attempt to privatize Medicare, as thought leaders script simplistic approaches that very frankly miss the point, it is up to primary care doctors and their patients to right the raft and move us forward. Today reform is tossing more regulation and time/financial burdens on our laps without improving heath care quality or reducing Medicare's cost. We as primary care doctors must lend our voice to the debate. I welcome all input to this blog, and together we can make a difference. Currently polls show that 85% of primary care doctors feel that they have no impact on the direction of health care, and a vast majority are frustrated by the changes being thrust at us. There is only one way to change that: put our heads togehter, and tell the policical and medical community that we will be silent no more. My book is a first salvo to what must be our prolonged fight to change Medicare's course and make a positive impact on the health of our elderly patients. I hope that there will be more discussion ahead and that we get past the rapids to calmer water.

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