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SCVNews.com | Opinion/Commentary: Two-Tiered Healthcare System | 08-08-2016
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Commentary by Gene Dorio, M.D.
| Monday, Aug 8, 2016

genedorioBorn in Canada, our mother came to the United States after World War II and blended into the Greatest Generation. Raising a family in the second half of the 20th Century saw her contribute to a thriving American society then maintain retirement health on Medicare. But in her early 90s, this tranquility was threatened when her HMO hospital tried to kill her.

She went to the emergency room with symptoms of the stomach flu and was rapidly placed on palliative care with an erroneous diagnosis of end-stage liver cancer. Fortunately, after a long ordeal and because of our medical background, we thwarted hospital personnel’s efforts and got her back home, healthy.

Because healthcare spending is 17.5 percent of the nation’s Gross Domestic Product – by far the highest in the world – legislators have focused on lowering this figure. Some of the financial assault has come against Medicare, creating a two-tiered system endangering the health of the Greatest Generation.

As a primary care physician, I have seen this onslaught perpetrated against elder senior patients who are admitted to the hospital.

In the Medicare tier, patient reimbursement has been legislatively lowered, and therefore hospital admissions have been statistically scrutinized. “Length of stay” is a common term that business-oriented hospital administrators use to bully primary care physicians hurriedly to discharge still-ill patients to nursing homes. Multiple case managers and discharge coordinators are employed to hover over doctors expediting “drive-thru” medical care.

Some patients, though, are extremely ill, and hospitals have maneuvered and exploited end-of-life hospice laws. Unlike our mother, many patients do not have physician family members guiding them through this ordeal.

In the second tier, patients who have private insurance and are under 65 do not come under the same scrutiny Medicare patients undergo. There are no delegated in-hospital oversight personnel, and I rarely receive phone calls from insurance companies to discharge the patient. Patients stay longer, leave healthier, and there is never a length-of-stay statistical report generated to coerce their primary care physician.

So those elder senior patients – our parents and grandparents who fought in wars and defended our nation, made it through the Great Depression and established vested interest in the future of our nation – are swooshed into and out of the hospital in a legally sanctioned attempt to minimize their medical care.

Shouldn’t legislators be more responsible? Of course. But the caveat to this scheme is that the members of Congress who make these laws don’t go on Medicare like the rest of us. They have health insurance outside of the Medicare system. This undermines our ideals of equality, as the legislators who make the laws don’t live under the laws.

Not fair? We have moved forward on many issues, and most of us now believe the Constitution should read, “all men and women are created equal.” The same should be said for healthcare. Let’s get rid of the two-tiered system of hospital care and find a better way to provide Medicare to the Greatest Generation.

For a start, demand that all members of Congress go on Medicare at age 65. They will then have vested interest in their future, as well as ours.

 

 

Gene Uzawa Dorio, M.D., is a housecall geriatric physician on staff at Henry Mayo Newhall Memorial Hospital and has been engaged as an advocate in many community activities. The views expressed in this column as his alone.

 

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3 Comments

  1. Mbb says:

    THANKS for the article – hope it scares families into making sure that anyone in their family receiving Medicare has a loud and educated (to the above) advocate. My older sister in St. Louis was in the same position til I stepped in at great expense.

    Don’t let it happen to you, either – plan ahead!!

  2. S.Smith says:

    I respectfully disagree with your assertion of a two-tiered system based upon age and being a Medicare recepient. Young people are also subject to scrutiny, approvals and authorizations by their insurance plans, especially HMO plans. Even more at risk are those with no insurance, for which there is no private nor government payer. And what about our veterans who have received inadequate care at some VA hospitals.
    I don’t believe every, nor most, physicians, hospitals, or health plans are as “slanted” as your portray.
    I’d like to present an alternate portrait of an experience with an elderly family member where the physician wanted to admit my family member to the hospital for multiple minor medical issues that arose. I don’t think the physician was a bad physician. I don’t think they wanted to spend the additional time managing my family member at home. Advocating for care aligned with the family member’s desires and values, we switched our family member to a practice with a Physician’s Assistant who was willing and capapble of managing care that prevented hospitalizations and kept our family member at home.
    I appreciate commentary and Op Ed pieces as long as they are accurate. I don’t find this one completely accurate and recommend SCVnews.com find another contributor.

  3. Gene Uzawa Dorio, M.D. says:

    In response to S. Smith:

    In the article, traditional Medicare is being compared to those using private insurance in a hospital setting.

    HMO Medicare (briefly alluded to in the posting as it applied to my mother) is one of several insurances reimbursing hospitals for medical care including Medi-Cal (federally it is Medicaid), Affordable Care Act (known by the public as Obamacare), and the Veterans Affairs (usually at their government set-up hospitals).

    Those unfortunate patients who still have no health insurance (about 20 million in the US) are the most victimized, but were not discussed in this posting.

    I agree with you, younger patients in regular HMO (as well as older Medicare HMO) are clearly under the scrutiny of management, as their administrators are there to make a profit. Because of this motivation though, some physicians, hospitals, and health plans are “slanted” when they provide care. This was also not discussed in the article.

    Even as a physician, I find these areas complex. Still, I stand by the accuracy of my commentary.

    Gene Uzawa Dorio, M.D.

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