Common Sense Medicare and a Balanced Budget

Political commentators and radio hosts often rant that the deficit can be solved by "eliminating waste." If only they had some idea what "waste" was, other than "fraud" - which sends people to jail. Republicans want smaller government, at the expense of Democrat's sacred cows of Medicare and Medicaid. After considering the comments of several doctor friends of mine, apparently the politicians never bothered to ask doctors how to eliminate waste!

You've probably heard of abuses like poor people using ambulance rides to emergency rooms for an aspirin. It happens. I've seen free rides used to get a lift near a liquor store. What can be done? Are there answers? And where does the most money get lost?

The answers are yes, yes and "in the cracks." But there are obvious solutions. I'm talking about patient misuse - as opposed to fraud by providers or expenses by Big Pharma: those battles are already being fought. The first step: national patient registration.

HIPAA has been an effort to standardize and automate medicine to make medicine more confidential, safer, and more cost effective. A national registry could also be used to record service misuse.

Here is a specific example you may not have heard or considered. One Family Practice friend of mine - in an inexpensive area that is undeserved because few physicians want to deal with Medicare and Medicaid that have no patient accountability and low pay - went to work a few days ago. None of her patients kept their appointments. With public assistance, the people skipping their appointments were billed nothing, the patients have to have future appointments scheduled, and the medical system is out a day of work. For a regular Family Practice Physician, that is almost $1,500 - or nearly $3,000 with overhead that will be billed via other clients. No one got care, other lives could have been saved, and the patients on public assistance faced no consequences.

If we want to balance the budget a global registry for health care must be created with universal accountability. No matter how poor you are, if you miss an appointment you should be denied health care until that missed appointment is paid for - in cash.

Working people can't afford to go to the emergency room for a band-aid - and neither should people on public assistance. Anyone going to the emergency room for a non-emergency should be denied health care until that visit is paid for - in cash.

As we try to ensure health care is accessible to all, we all have to be accountable - especially where that accounting is normally not in dollars and cents.