Home Care Program Would Cut Costs


Usually the bell rang when someone wanted to gain entrance, but this time there was a sharp rap on the door.  I opened it warily and just escaped a tap on the noggin as Dr. Ernest Crabgrass pushed the door open and entered, brandishing his cane.


“Why hello, Dr. Crabgrass, this is a surprise,” I said.          


“Where’s Lapius?” he asked without bothering to acknowledge my greeting.


“One moment please, I’ll find out,” I left Crabgrass who still caressed his cane like a shillelagh, and marched to the living room.  “Crabgrass in the foyer,” I told Lapius.


“I don’t want to see him.”


“What should I tell him?”


“Tell him I have the mumps and difficulty walking.”


I turned to transmit the message and ran right into Crabgrass, still waving his cane.  “Don’t worry, Simon.  I’ve already had the mumps.”


Lapius gave Crabgrass a warm welcoming smile and threw his arm around the still frocked shoulder of the uninvited guest.  “Goodness, Ernest, it has been a long time.  Welcome, welcome.  What brings you to this neck of the woods?”


“I want you to sign this petition, Simon.  I won’t take ‘no’ for an answer.”


“And what petition is that?  The one to abolish Medicare?”


“Exactly.  Here.”  Crabgrass laid a smudged paper on the table and handed Lapius a pen.  Lapius took it, leaned over, read the petition carefully and then marked a big X in the appropriate space.  “There you are Crabgrass.  I’ve signed it.”


“An X won’t do, Simon.”


“You don’t think I will put my real name on that ridiculous document, do you Crabgrass?”


“Why not?”


“First, because I don’t believe in the petition, and secondly, because Congress is not going to repeal Medicare.”


“They should.  They have no right to interfere into medical affairs.”


“Well, I would agree with that.  But they do have the right to pay medical bills if they want.”


“But by paying medical bills they earn the right to dictate to the medical profession.  That interferes with our professional freedom and I for one am against it.”


“Come now, Crabgrass.  Surely you must understand that we can’t go back to the old days where old or elderly people were relegated to the back rooms of their children’s homes.  They certainly couldn’t afford protracted illness.  Surely we can’t allow the nest-egg for retirement of an elderly couple to be wiped out by illness.  That isn’t the American reward for industry and diligence and prudence over the years.”


“Perhaps not, but surely it isn’t the American purpose to preserve the nest-egg by dumping these people in nursing homes.  Have you seen any of these lately?  Even the best offer little more than anonymity and ignominy.  Some of those people would be much better off dying at home amongst their loved ones.”


“That’s a point, Ernest,” Lapius agreed.  “Maybe you should rewrite your petition.  Instead of trying to wipe out Medicare, request that it includes a home care program.”


“What is a home care program?”  Crabgrass asked.  “More of your socialist mumbo jumbo?”


“Hardly, Crabgrass.  It would be a program that would permit the elderly to be taken care of at home.  After all, the average convalescent home costs a minimum of $5,000 per year per resident or patient.  For the same money most of these people could be adequately taken care of at home by the family in conjunction with a home health aid.”


“My goodness, Simon, that would be open season for larceny.  The government couldn’t trust families to receive a $5,000 subsidy to take care of a sick father.  They might blow it at the race track.”


“Sure,” Lapius agreed.  “Some might.  But then, some might not.  Certainly a family would seem a more dependable receptacle for subsidy for the care of one of their own, than the impersonal management of a distant nursing home, in which personnel is always changing.  After all, Crabgrass, there are situations which are reasonably self-governing, and it seems to me that family care at home for a sick person is one of these.”


“How would it work?  I mean, how would the government know who is sick and deserving and who isn’t?”


“All the government would need would be the testimony of the family doctor, and-or the affidavit of a social work agency to affirm the need.”


“Ha ha, Simon, you are opening the floodgates.  People could fake that and steal the government blind.”


“Some might, but it would still be a hell of a lot cheaper for the government to trust its citizens, than to distrust them and set up a whole supervisory administration whose only job is to see that the government isn’t cheated by its citizens.  It would be more dignified too.  Actually by setting up utilization committees and Professional Standards Review Organizations, the government castigates the medical profession, and impugns the honesty of the doctors.  I personally resent it.”


Crabgrass was becoming impatient.  He seized the moment.  “Ah, Lapius.  So we agree.  Medicare must go.  Sign the petition.”


Lapius sighed.  “Poor Crabgrass,” he said patronizingly, “You didn’t understand a word I said.  It is you who must go, not Medicare.  Harry, show Dr. Crabgrass to the door.”