In the previous blog I posited the notion that today’s elder population, of which I am part, will probably be the last one to set records for longevity in the 21st century. I already have pointed out the first of two major reasons for that notion, namely personal indifference to one’s health, and now I will address the second reason; the negative influence of government bureaucrats on the delivery of healthcare. That in turn is sub-divided into three lines of direct causation, the decline of numbers in physicians devoted to primary care, the government induced lack of incentive for the remaining primary care physicians to accept the elder population into their practices and the rationing of healthcare to the senior population.
Because primary care provides the lowest net income of all types of medical practice, and because every person graduating from medical school these days brings forward an educational debt of approximately $150,000, more than 60% of the graduates from our nation’s medical schools are entering more lucrative specialty residency and subspecialty fellowship programs. Since self referral to a specialist is frowned upon by insurance companies and the Medicare program, one must be referred by one’s primary care physician. The logical expectation to evolve from a shortage of primary care physicians will be a delay in the referral process. That delay may well defer the discovery and treatment of a curable cancer that will have proliferated to a higher, incurable stage during the waiting period.
The US government has already made it unproductive, from a cost of practice perspective, for primary care physicians to take on new Medicare patients, and some have even told their current Medicare covered patients that they can no longer afford to have them in their practice. My personal physician, a very busy internist, recently had to borrow money from his retirement plan to pay the overhead in his office. People over 65 have more illnesses, take a greater number of medications that require frequent monitoring, demand more office time and need to be hospitalized more often than a younger group of patients. By making reimbursement rates lower for the Medicare population the government surreptitiously produces another form of rationing.
One additional rationing method now present in the Affordable Care Act of March 2010, known familiarly as “Obamacare,” is a provision that uses a formula in determining your need and mine for a particular procedure, diagnostic study or definitive treatment. The decision to move forward with the needed care will be based upon a ratio of what the proposed medical care will cost divided by one’s life expectancy. For example if you need an MRI that costs $1200 and your life expectancy is 10 more years (according to the life insurance actuarial tables), your MRI’s ratio of expenditure is 120. If on the other hand you have another 20 years of life your ratio is 60. In a system of rationing (note that ratio is part of that word) the person with a numerical score of 60 would move ahead of a person with a 120, in the line awaiting an opening in the MRI facility’s schedule: thus delaying both the discovery and treatment of a serious illness. Of course, the higher the cost of the procedure, test or treatment the greater the difference in scores. If your surgery costs $12,000 and you have 10 years of life expectancy, people needing that same surgery with longer life expectancies, will be put on the operative schedule ahead of you. I have no complaints: Having been raised by the greatest generation, I have been privileged to have lived among the oldest generation of the previous three millennia.