In Medicare Meltdown: How Wall Street and Washington are Ruining Medicare and How to Fix It, ($25, Rowman & Littlefield), authors Rosemary Gibson and Janardan Prasad Singh explore the ties that bind Wall Street and Washington and how that impacts the country’s healthcare system. Gibson talked about the book with Healthcare Finance News.
Q. Please give us a brief description of your book, and share with us what you think is its most important take away for readers.
[See also: Reading List: "Catastrophic Care"]
A: Medicare Meltdown looks at the business of Medicare: where the money goes, who gets it and what they are really doing with it. The book shows how Medicare is highly lucrative for some of the biggest companies in the world. They have become dependent on Medicare's money. A culture of dependence has morphed into an entitlement mindset, which breeds enormous amounts of waste and misspent money.
I suggest that the solution to Medicare's fiscal woes is not to cut seniors' entitlement to Medicare by raising the eligibility age or increasing premiums. Instead, the healthcare industry's sense of entitlement to Medicare's money is what should be cut. I give examples of where to apply the budget scalpel.
Q: How can (or can) the business interests of the healthcare industry be aligned with responsibly using Medicare?
A: Right now, there is no limit on how much Medicare can spend this year and in coming decades. The country will go off the rails if the status quo continues. This will happen in my lifetime, absent reforms.
[See also: Reading List: Fredric Tobis, 'The Healthcare Crisis: The Urgent Need for Physician Leadership']
Both President Obama and Congressman Paul Ryan have proposed setting limits for how much Medicare spending can increase per year, tied to growth in the economy. If Medicare had a budget, the conversation would change overnight. Finally, we can ask: "How can we achieve the best health outcomes for Americans with the money we are spending?" This approach can help align business interests with the responsible use of Medicare's money.
Q: You suggest that healthcare companies should not be held by the traditional law governing corporations – that those laws be revised for healthcare companies or that those companies should be governed by different corporation rules altogether so that duty to the patient rather than to the company's bottom line is legally established. Would you explain this idea for our readers and share how you think such a solution would work?
A: In Medicare Meltdown, I make the point that doctors and nurses have, as a condition of their license, a primary duty to patients. Many of them, however, work in healthcare facilities that do not have that same primary duty to patients in statues governing their establishment. This creates an untenable conflict of interest. A doctor or nurse may want to act in the best interest of the patient, but the facility where they work may have different laws and norms.
A case in point: patients may undergo unnecessary back surgeries or cardiac procedures because the hospital benefits financially, as do the companies that manufacture the devices, drugs and supplies used during the surgeries. Meanwhile, the patient is put in harm's way. This is a classic example of privatized gains and socialized losses. The hospital and drug and device companies make money while the patient suffers and pays the cost, along with society.
I suggest that any entity whose products or services affect the health and well-being of patients should have a primary duty to patients that trumps all other duties, including fiduciary duty to shareholders. On the one hand, it may sound radical. Yet the principle is fundamental to the tenets of medicine that the public should expect nothing else.