After Half a Century of Medicare, American Medicine Is at a Crossroads


In celebrating the 50th anniversary of Medicare, its supporters are overlooking or denying the troublesome facts, writes cardiovascular surgeon Donald W. Miller, Jr., M.D., in the fall issue of the Journal of American Physicians and Surgeons.

Almost immediately after enactment of Medicare and Medicaid, spending on medical care began to escalate, from 5.2 percent of GDP in 1960, reaching 17.4 percent in 2013.

The government response has been to impose increasingly severe price controls and regulations, despite promises in the law not to interfere in the practice of medicine or remuneration. Bureaucrats dictate what is medically necessary or appropriate. Rules are becoming so complex that it may become impossible to practice outside a large organization that can afford the risk managers, accountants, and lawyers needed to ensure compliance, Miller states.

Recently, the so-called Patient Protection and Affordable Care Act (ACA) moves us still further down the road to government control, and at high cost. Then, the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act (MACRA) rescinded the oft-delayed Medicare physician fee cuts under the Sustainable Growth Rate (SGR) formula, only to replace it with a still more intrusive administrative pricing system.

Medicine is becoming industrialized, Miller states, and “doctors are becoming like assembly-line workers, practicing medicine according to federally prescribed guidelines.” These guidelines, developed in a culture of crony capitalism, can endanger patients’ lives. He gives the example of demanding tight blood sugar control in cardiac surgery patients.

“Traveling the government road in medicine stifles innovation, inundates healthcare workers with regulations, and rations care. Costs soar, despite price controls, draconian monetary penalties, and bounty-hunter recovery audit contractors,” Miller writes. Further down this road lurks the Complete Lives System, which restricts care for older persons. At the end, “redistribution of wealth will be coupled with redistribution of life years.”

Miller advocates taking another road, the “one less traveled by,” which leads to freedom.

“At some point,… the currently traveled government road will wash out and become bankrupt, either gradually as its healthcare programs become more and more smothered in paperwork, or abruptly.” In contrast, he concludes that “free-market medicine offers us the best chance for preventing disease and developing cures for existing, currently incurable chronic diseases, where longevity with well-being is the ultimate goal.”

The Journal of American Physicians and Surgeons is published by the Association of American Physicians and Surgeons (AAPS), a national organization representing physicians in all specialties since 1943.

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