Medical Costs
“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.”