Avoiding Futile Care and Reducing Medicare Costs

If we in the U.S. ever hope to get a grip on Medicare costs, our society will first have to navigate a steep learning curve. That’s the lesson to take from three recent publications. 

Despite the fact that Medicare is expected to represent 18% of the federal budget in 2020 (up from 15% in 2010), and that the Medicare Part A Trust Fund is projected to have insufficient funds to cover all hospital bills starting in 2024, polling guru Robert Blendon reported that 47% of the public do not see Medicare as a large budget item, and only 31% see it as a major contributor to the federal deficit!

Here are some of the key findings from Blendon’s study:

  • Respondents believe that Medicare recipients receive benefits worth about the same (27%) or less (41%) than what they’ve paid in. In reality, beneficiaries on average pay 1$ for every 3$ of benefits.
  • By a 3-to-1 ratio, the public believes the bigger problem under Medicare is people not getting the care they need, as opposed to receiving unnecessary care. This is despite a recent report from ICU physicians discussed by Muriel Gillick in a recent post that among their Medicare patients 15% received care that was “futile” and 12% received care that was “probably futile.”
  • Although administrative costs for Medicare are substantially lower than for private insurance, only 15% believe that Medicare is better run.
  • Every age group prefers physicians to be paid on a fee-for-service basis. The 18-to-29 year olds are the most open to capitation payment (42%).
  • With increasing age, opinions about Medicare become progressively more favorable: 18-to-29 year olds (61%); 30-to-49 year olds (71%); 50-to-64 year olds (75%); and, for those over 65 (88%).

Finally, a survey done by The Conversation Project – an admirable organization “dedicated to helping people talk about their wishes for end-of-life-care” – found that while 90% of us believe we should have these conversations with those we’re close to, only 30% of us have actually done it.

Taken together, the three publications define a three-pronged learning task that must be accomplished for Medicare to reduce overtreatment and help contain costs. We seniors need to spread the word that 1) contrary to the views of almost half of our population, Medicare is indeed a major contributor to the financial problems of the working public, 2) we seniors receive a substantial amount of ICU care that medical experts believe is “futile,” and 3) most of us probably don’t want that “futile” care, but our families and friends won’t speak up for us if we haven’t had the discussions of our values for end-of-life-case that The Conversation Project encourages.

 James Sabin, M.D., 74, is an organizer of Over 65, a clinical professor of psychiatry at Harvard Medical School, and a Fellow of the Hastings Center.





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