CURING MEDICARE

A gerontologist’s take on what is needed to reform Medicare.

Lazris (The Blue Gene War, 2004, etc.) finds fault with Medicare’s payment rules and believes the system may undermine the health and well-being of elderly patients. The author notes that Medicare reforms in the Affordable Care Act failed to provide safer, affordable alternatives to frequent hospitalizations for treating the elderly. Lazris, a primary care geriatric physician and medical director at facilities for the frail elderly, advocates a minimalist approach to medical interventions for many chronic health problems of advanced age, including dementia. He argues that Medicare’s outdated payment rules and assumptions about life expectancy are financing “an interminable search for eternal life” instead of ensuring that Medicare pays for long-term “palliative” care, ideally at home. “[W]ith age comes a decline that no amount of dollars will curtail,” Lazris writes, although the elderly and their families often think otherwise. One of his female patients petulantly “fired” him, labeling the good doctor a “nincompoop” for taking her off a statin drug that he believed was doing her more harm than good. Lazris devotes the final part of his book to proposing Medicare policy changes to reduce “excessive use” of expensive medical tests and medications for treating the inevitable losses of aging. The author concedes that changing Medicare will be difficult. Some obstacles to reform may be too entrenched, but Lazris presents a convincing case for introducing modest financial “disincentives” into the Medicare payment system, which might include $50 copays for appointments with certain types of medical specialists, $100 copays for procedures such as MRIs and $200 copays for every trip to a hospital emergency room—all paid for out of pocket. With an insider’s view, the author does an excellent job of diagnosing pervasive problems in the Medicare system.

A fascinating look at how Medicare must change.