In the article "Trustee warns that Medicare is heading for insolvency" (Oncology NEWS International July 2007, page 26), Dr. Thomas Saving made some excellent recommendations for changing how Medicare is financed. There is, however, one recommendation that Dr. Saving alluded to, but did not emphasize, when he stated that "beneficiaries are shielded from the fiscal realities of the medical care they consume."
This situation is further exacerbated by the care delivered, especially end-of-life-care, at the patient's directive. Thus, often patients and their families want everything done because that is the only way the patient can stay in the hospital and avoid home care and costs. Often these patient directives also economically benefit the caregivers.
In the current healthcare system, there are lots of winners. The only losers are the next generation of Americans, who will be left with the tab.
Unless we use incentives and disincentives in healthcare by denying payment and/or enforcing Dr. Saving's advice that "the first dollars spent on healthcare are the responsibility of the consumer," the US healthcare delivery system is unlikely to see much improvement.
Gilbert A. Lawrence, MD, DMRT, FRCRRadiation Oncology, Faxton Hospital Cancer CenterUtica, New York