September 13, 2003


Patients in Florida Lining Up for All That Medicare Covers: Boca Raton, researchers agree, is a case study of what happens when people are given free rein to have all the medical care they could imagine. (GINA KOLATA, 9/13/03, NY Times)

Boca Raton, researchers agree, is a case study of what happens when people are given free rein to have all the medical care they could imagine. It is also a cautionary tale, they say -- timely as Medicare's fate is debated in Congress -- for it demonstrates that what the program covers and does not cover, and how much or how little it pays, determines what goes on in a doctor's office and why it is so hard to control costs.

South Florida has all the ingredients for lavish use of medical services, health care researchers say, with its large population of affluent, educated older people and the doctors to accommodate them. As a result, Dr. Elliott Fisher, a health services researcher at Dartmouth Medical School, said, patients have more office visits, see more specialists and have more diagnostic tests than almost anywhere else in the country. Medicare spends more per person in South Florida than almost anywhere else -- twice as much as in Minneapolis, for example.

But there is no apparent medical benefit, Dr. Fisher said, adding, "In our research, Medicare enrollees in high intensity regions have 2 to 5 percent higher mortality rates than similar patients in the more conservative regions of the country."

Doctors say that Medicare's policies are guiding medical practice, with many making calculated decisions about whom to treat and how to care for them based on what Medicare covers, and how much it pays. [...]

It is easy to find all these specialists, he said. "You get recommendations at the clubhouse, at the swimming pool. You go to a restaurant here and 9 times out of 10, before the meal is over, you hear people talking about a doctor or a medicine or a surgery." And of course there are the other patients in all those waiting rooms. Mr. Bloomberg even recommends specialists to his own doctors.

But some patients say they are frustrated by what they call a waste of resources. "The doctors are raping Medicare," said Louis Ziegler, a retired manufacturer of flight simulators who lives in Delray Beach.

Mr. Ziegler recalled going to a doctor for a chronic problem, a finger that sometimes freezes. All he wanted was a shot of cortisone. But he got more, much more: "I had diathermy. I had ultrasound. I had a paraffin massage. I had $600 worth of Medicare treatments to get my lousy $35 shot of cortisone."

Dr. Colton, the internist here, is frustrated, too.

"The system is broken," he said. "I'm not being a mean ogre, but when you give something away for free, there is nothing to keep utilization down. And as the doctor, you have nothing to gain by denying them what they want."

It may be a case study, but do you really need a study to know that when government pays for something it multiplies beyond all reason and its costs skyrocket?

Posted by Orrin Judd at September 13, 2003 6:12 AM

The fact that no one has responded to this post shows just how difficult it is for 'conservatives' to address the issue of entitlements, especially Medicare on either technical or philosophical terms).

Posted by: jim hamlen at September 14, 2003 11:15 PM

Well, most of the people here realize that entitlement programs inevitably lead to soaring costs and diminished services. Medicare is one of the many debacles of the "Great Society".

Conservatives have addressed these problems in a thoughtful and responsbile way. And were demonized for there trouble. In many cases the New York Times lead the charge. Politicians will no longer follow down the daring path set by Newt Gingrich and other conservative leaders until media outlets change their coverage into something more responsible and thought provoking, rather then the previous "MediScare" techniques.

Perhaps this article represents a more responsible take on the issue by the New York Times.

I doubt it.

Posted by: doug at September 21, 2003 8:15 PM

Howard Dean is right - Medicare is a dreadful system and it is administered dreadfully!

Posted by: Eleanor Bergquist at October 29, 2003 12:21 PM