Medicare must control wasteful spending
As a primary care physician who cares for elderly patients, I read the editorial "Health care reform" (Dec. 26) with interest.
The editorial correctly pointed to the obscene discrepancy between the salaries of primary care doctors and specialists as part of the problem in providing cost-effective medical care. But the real question is why specialists earn so much and use up such a disproportionate percentage of our health care resources.
Medicare could easily fix the problem by altering its reimbursement policies and limiting visits to specialists, and leaders of Medicare have been talking about doing just that for 20 years. But they have done nothing. Why?
The answer is simple. The people of this country, prompted by the media and politicians, erroneously believe that more testing is better than less, that specialists provide better care than "general" doctors, that being in a hospital leads to better care than being at home and that any restriction on access to tests and doctors is akin to socialized medicine and leads to bad outcomes.
Our very medical ethos has led us into this mess, and our politicians do not have the political courage to curb spending on patients.
As someone who works within the Medicare system, I see patients and family members demanding services that cost thousands of dollars because they can do so without any restriction or cost to themselves. Some of these patients are very old, demented and terminal. The tests and treatments are usually excessive.
But in a Medicare system in which the patient can get nearly everything he or she wants for practically no cost, and in a country that believes more is better, this cycle of spending knows no end.
Unless we can change the nature of our medical culture and restrict our excesses, not only is a universal health care system doomed but the systems we have now will collapse under the weight of our insatiable appetites.
Dr. Andy Lazris, Columbia
Time to reorganize the delivery of care
Dr. Thomas F. Lansdale III's comments on retainer-model medical practice underscore the complete failure of the free market to deliver quality medical care at a reasonable cost ("In defense of so-called concierge medicine," Dec. 29).
