Twenty-eight (1972-2000) years practicing medicine in the US and eight (2000-2008) in Europe have taught me that we have a much better system than Europe both in terms of quality and proportional waste. Yet, our waste in healthcare is ruining this country. The root of the problem is that healthcare is “free”: once we pay our taxes, Medicare is going to take care of us. This year I will become Medicare eligible. And, although it may cost us some effort, a large proportion of us Medicare beneficiaries would probably do a very decent job at managing the Medicare dollars if we had more of an incentive to do it.
Current thinking here is: By having expert panels Medicare is going to be able to limit expenses. Naïve. It has been tried unsuccessfully many times before. When people are told that they cannot use a resource they get for free, they become even more motivated to using it. Witness the uproar a little over a year ago over the guidelines for mammography screening.
As a doctor I have experienced many times the lack of confidence of a patient who feels that I am not prescribing a test or a medication to save money for Medicare. Exactly the opposite (logically) happens when they pay for the expense. Then, as a good consumer, the person requests the reasons why the expense should be made. And if an unscrupulous doctor recommends an expensive surgery or test just to make money, people will get a second opinion when it is a question of their money. They are much more likely to go for it when Medicare or Medicaid pays, as a number of studies show.
The government should study a way to incentivize people to become again the administrators of their money. They do a much better job than uncle Sam or the insurance companies. Not to speak about the surge in quality of care that we would experience if doctors and hospitals again become responsible to individual patients and their families.