Opinion
Medicare and Social Security can't be sustained as currently operated
LETTER — Posted June 18, 2007
Regarding "Annual Medicare trustees report issues dire forecast for Part B" and "Battle over futile care erupts in Texas" (Article, May 14): The same issue of AMNews that headlined on page one the dire forecast for Medicare Part B discussed, inside the newspaper, the battle in Texas regarding futile care. The General Accountability Office recently stated that significant changes must be made in Medicare and Social Security to avoid national bankruptcy.
My father, in the AMA 40 years ago, opposed Medicare and predicted that this day would come. Now organized medicine again sits at a critical nexus with the opportunity to save our nation. This issue is more vast than most members understand.
If we are to salvage Medicare at all, we must have a valid national debilitation scale that considers chronic and irreversible disease conditions, irreversible mental deterioration, overall physical condition and age, and whatever other valid and reproducible criteria may be deemed of most value. When a Medicare beneficiary reaches such a state of deterioration that it is statistically found that recovery to a functional state is unlikely and further efforts are futile, then only hospice care should continue as a benefit. Further treatments are not prohibited, except that if the family insists upon it, then the financial obligation rests upon the family.
What we have been doing for the past 30 years is neither the best practice of medicine nor is it humane. Doctors have relinquished decision-making to patients and their families who do not have the knowledge nor the impartial distance necessary to make such difficult decisions. This has resulted in health care beyond reason. It has resulted in poor, unfortunate souls continuing their unaware lives for many years until their inevitable pressure ulcers, then the inevitable nursing home lawsuit.
Ultimately Social Security must be privatized, at least partially, and Medicare must become a needs-based system.
The entire concept of egalitarianism is absurd, and there is not enough money in the world to provide a premier product to all the people if they are told to take what they think they need and pay into the common pot what they think they can afford.
The most efficient form of health care is the free market, in which patients pay the physician directly and price competition reigns, such as in cosmetic surgery, Lasik and few other examples.
A country that goes bankrupt and is unable to pay police, army, pensions and the government itself -- however inept --historically has descended into chaos, blood in the streets and anarchy until the people demand security and stability by calling for the toughest hombre in the corral, usually the tyrant who was creating all the chaos in the first place. Tyrants intuitively grasp for power when the setting is right. Do we really want to go down that road, or are we willing to make the tough choices?
America is the last best hope for mankind for a long, long time, and our failed experiment in socialism is apt to bankrupt us unless we turn away from it very soon. I encourage my colleagues to have faith in themselves and do not fear the free market.
William D. Strinden, MD, Lufkin, Texas
Note: This item originally appeared at http://www.ama-assn.org/amednews/2007/06/18/edlt0618.htm.