Disclaimer: I am no Medicare or health care expert. I have a few facts, some ideas and suppositions that make sense to me. My only expertise, if you can call it that, is having parents who are or have been on Medicare.
I like the Romney/Ryan plan for Medicare. It makes good fiscal sense to save money and save the program. It makes sense that people should take a little more responsibility for their care, and the Romney/Ryan plan would allow seniors to make cost-effective choices in their treatment, preventing unnecessary costs to Medicare. It's even endorsed by Paul Ryan's mom, as we saw when she joined him last week in Florida!
It seems that Ryan's mom may have helped a bit in her fellow Floridians' acceptance of the Romney/Ryan effort. In a recent New York Times/CBS/Quinnipiac poll, 48% of Florida seniors say Romney would do a better job on Medicare; 44% said that about Obama.
According to the plan, starting in 2023, new retirees would get a fixed amount of money from the government to pick either private health insurance or a federal plan modeled on Medicare. They can choose what is best for their situations, taking a little more responsibility for themselves and expense they will incur. Right now, health care is a free-for-all.
Recently, I wrote about the "barnyard behavior" exhibited by people who become pigs when they take advantage of free things. They tend to take more because they can. There is no other logical reason why they do.
The same must be happening with Medicare. If it's free, then of course you would take advantage of it and not question doctor's orders for unnecessary testing or expensive drugs. There is certainly an incentive for the medical community to over-order because they are worried about lawsuits, or because they profit from it.
Here are a few family examples:
My mother is in her 80s, and lives in the Sunshine State. Without consulting her, her doctor ordered oxygen for her to use at night when she complained about difficulty sleeping. I can tell you, after spending extended time with her, that the noise of the pump was enough to keep both patient and houseguest awake into the wee hours of the morning. Add to that the annoyance she felt having something in her nose with a long tube that she worried about tripping over in the middle of the night. She didn't need the oxygen, and after trying to use it unsuccessfully for several months, sent it back. She said she was glad to save almost $200 a month for Medicare.
My dad had trouble cutting his own toenails. His doctor sent him to a podiatrist to give him regular "pedis," as we girls refer to our pedicures. Obviously it wasn't quite a footbath and beauty treatment, but it was excessive and paid for by Medicare. After a couple of visits, Dad decided it was not right for Medicare to pay for it and quit going.
Dad suffered a stroke a few years later and spent the last days of his life in a hospital bed, unable to move, eat or speak. We knew his death was imminent; treatment had been stopped, according to his wishes, except to keep him comfortable. When a lab tech prepared to take blood from my father, I chased the tech out of the room and complained to the nursing staff that they had better not perform any more unnecessary tests. Why did they need blood samples from a dying man who was not being treated? Medicare would have been charged for all of it, of course.
My mother's physician ordered a colonoscopy for her when she was 85 years old. She had never had one before, and had no symptoms to indicate tests were necessary. She refused. Medicare would have paid unnecessarily for a test that not only would have been expensive and was not needed, but which would have put my mother at risk due to the difficult test preparation and her sensitivity to anesthesia.
There are lots of examples of Medicare waste, and I offer a few before I suggest how we can save some money for Medicare:
Doctors can request more expensive name-brand drugs that work the same as the generics. $3.1 million was charged to Medicare Part D for erectile dysfunction drugs in 2007 and 2008. Medicare pays for unnecessary and expensive emergency hospital visits, including those for bronchitis and skin infections. Medicare pays for breast reduction if the patient experiences "back pain. My mom's nurse friend (also a senior) said she thinks doctors order unnecessary tests "so they don't get sued." 1 in 4 Medicare recipients gets expensive colonoscopy tests every seven years instead of the routine screening once a decade.
Patients and their families need to take more responsibility for the costs they are incurring to the Medicare system. "Because it's free" is not a good reason for getting a test, receiving equipment or visiting a doctor.
If every one of the approximately 49 million Americans receiving Medicare rejected $200 in unnecessary service next year, 1/12th of the annual cost of my mother's unnecessary oxygen, Medicare would be billed $9.8 billion less. If everyone rejected $2,400 in services, the annual bill for my mother's oxygen, Medicare would be billed $117,600,000,000 ($117.6 billion) less. That's more than 16% of the $716 billion that the President raided from Medicare to pay for Obamacare.
The barnyard behavior has got to stop. Would you really take advantage of all the "free" testing and services you didn't need knowing it was bankrupting Medicare and taking away from the benefit your children could receive? I believe that the Romney/Ryan plan would inject more responsibility into the behavior of Medicare participating seniors.
I wouldn't be opposed to an incentive to seniors for rejecting unnecessary services. With a $117.6 billion savings, Medicare could afford to provide movie tickets, silver dollars or other "free" incentives. Maybe feeding the need for something "free" with some inexpensive incentives just might work and get people to reject Medicare-paid services they do not need.
People have got to be more responsible, and doctors have got to stop ordering unnecessary tests because they are worried about lawsuits. That's tort reform, another problem entirely.