The Beast That Feeds On Itself.

As many of you know, I am a strong believer in allowing capitalistic market forces to create the correct balance of supply and demand.  To create the correct type of value and service available to a population.  Whether that be the correct number of primary care doctors.  The correct number of orthopaedic surgeons.  The correct number of pharmacies.  The correct number of nursing homes.  The correct number of hospitals.  Some folks argue that supply drives demand.  To some degree that's correct.  But I also believe, more importantly,  that demand, as defined by the never ending flow from the Medicare National Bank,  drives the supply.  And it drives it in a big way.

Without Medicare  funding (or any third party entity) ,  very few businesses in the medical field believe they could survive.  The free flow of money drives the availability of services.  And the services that thrive are those in which profit gradients are built into the system.  This is the nature of capitalistic enterprises.  This is procedural medicine.  The profit gradients, clear as day, as determined by the specialty run RUC.  And with the WIN-LOSE system of RVU (relative value unit)/SGR (sustainable growth rate)   doctors are forced to take up boxing gloves amongst each other to protect their free flow of unending cash.  It's all really quite sick.  The system of payment is built around the never ending flow of money that is destroying our economy from the top down.

What we are left with are  businesses that operate in a capitalistic cost structure  (rent, utilities, labor, landscaping, office supplies, taxes, legal and accounting services).  But the revenue portion is structured around unsustainable socialistic models which are crushing our country in a mound of unfunded mandates, devaluing our dollar and creating overt and covert inflation by way of increasing prices and decreasing dollar value.  The government has forced upon our nation a program which cannot sustain our economic viability for generations to come. A program that puts money in all the wrong places, while starving the services that are the brakes of the system.   And we are getting exactly what the system was set up for.

Volume.

Procedures

Technology.

Heroics.

We have established a system, and pay for it without  remorse, a system that hinges on the belief that we are all immortal.  We have created a fully funded system that has allowed our citizens to believe that we can fix everything, every time, all the time.  We have established, as standard of care, the belief that all illness needs treatment, all the time, with the most expensive options available.   The legal defense for standard of care is simple irrational when the standard itself has become irrational.   We have established a fully funded system that has allowed unmanaged expectations to thrive in a world of zero tolerance for complications of illness.  We have established a fully funded system that pays for the incredibly defensive medicine that plagues this country.  A defensive system that is the direct result of the unmanaged expectations of patients and the jack pot mentality of our legal system.  We have established a system where more medicine means more money.  Where patients are oohed and aahed by the fancy computers and the fancy swinging arms and neato machines in all the direct to consumer ads that plague our country.  Ads that further enforce the unmanaged expectations of our population.

We have been fooled.  All of us.  Fooled to believe that our government can continue to fund our immortal population.  We have been fooled as doctors, to believe that we cannot survive with out the free flowing spigots of money.

We are all fools.

In 2006, a 75 year old American could expect to live, on average, another 11.7 years.

In 1990, the average 75 years old could expect to live another 11.0 years.

In 1980, the average 75 year old could expect to live another 10.5 years.

In 1970, the average 75 year old could expect to live another 9.3 years.

In 1960, the average 75 year old could expect to live another 8.7 years.

In 1950, that was 8.4 years.

In 1940, 7.6 years.

A 75 year old in 1930 could expect to live another 7.3 years.

1920=7.5 years

In 1910, a 75 year old could expect to live another 7 years.

The data is shocking.

In 100 years the average life expectancy of a 75 year old has climbed but 4.7 years.  Since the inception of Medicare, that number is just 3 years of longevity.  When you look at this data one is forced to ask what role Medicare has really had in enriching the health of our senior citizens.  It's easy to argue that Medicare has had a much larger impact on the creation of demand than it has on the creation of health.

Insurance does not create health.  It creates wealth.  --Happy Hospitalist 2008

It creates wealth for everyone getting the pay out in the shell game that we are all paying for.  There is no free lunch.  There never was.  There never will be. We spend  1/2 a trillion dollars a year on 45 million folks.  That's over 10K a year per beneficiary.   What do we get for that?  We  get three years of life extension in 43 years.  That works out to 25 days of life extension, every year.  That's 500 billion dollars a year to extend life for 25 days.  That's reality.  That's $20 billion dollars a day.

And we do it because patients, doctors and politicians have been brain washed to believe we must.  Reality has left the building.  The politicians pay for it to stay elected.  The doctors do it to get paid.  The patients accept it because it's paid for. And everyone turns their cheek and says

"Not my problem."

Well, it's everybody's problem.  And nobody has any incentive to put the brakes on.   Just like the days of staking your land in the wild wild west,  we have millions upon millions of corporate players each claiming stake to the giant pot of gravy  in the Medicare National Bank.

And none of them care about anybody but themselves.  Such is the American way.  The government's solution is to create more regulation, more layers of complicated rules, more expense to the cost structure, more inefficiency in the documentation games.  To make it more complicated.  To make it more expensive.  They have created a beast that feeds on itself.  May I offer my suggestion...