Jewish World Review Dec. 26, 2003 /1 Teves, 5764

Drs. Michael A. Glueck & Robert J. Cihak

The Medicine Men
JWR's Pundits
World Editorial
Cartoon Showcase

Mallard Fillmore

Michael Barone
Mona Charen
Linda Chavez
Ann Coulter
Greg Crosby
Larry Elder
Don Feder
Suzanne Fields
James Glassman
Paul Greenberg
Bob Greene
Betsy Hart
Nat Hentoff
David Horowitz
Marianne Jennings
Michael Kelly
Mort Kondracke
Ch. Krauthammer
Lawrence Kudlow
Dr. Laura
John Leo
Michelle Malkin
Jackie Mason
Chris Matthews
Michael Medved
Kathleen Parker
Wes Pruden
Sam Schulman
Amity Shlaes
Roger Simon
Tony Snow
Thomas Sowell
Cal Thomas
Jonathan S. Tobin
Ben Wattenberg
George Will
Bruce Williams
Walter Williams
Mort Zuckerman

Consumer Reports

Medicare Bankrupt: A Possible Palliative | Nearly everyone agrees: In its present form, Medicare is doomed to bankruptcy.

Within this unanimity, however, are three very different points of view.

The Leftists and socialists among us want it to happen, in order to force a complete government takeover: To borrow an old Vietnam analogy, "We had to destroy the system in order to save it."

Meanwhile, some political conservatives - especially those Republicans facing re-election next year - shrug it off with the Enron attitude: "When insolvency is inevitable, make the most of it."

Thirdly, most Americans go about their business with a kind of Scarlett O'Hara "I'll think about that tomorrow" resignation.

Let's think about it today. Specifically, let's consider a proposal put forth by Philip R. Alper, M.D., the Robert Wesson Fellow at Stanford's Hoover Institution. Dr. Alper suggests that Medicare become, at least in part, a "wealth-based loan program." This reverses the pre-1965 practice of "means testing," which required virtual indigence before admission to government health care programs.

No one suggests this would be a complete solution, but it would help break up the "one size fits all" logjam that currently dominates thinking about the Medicare program. Congress and the president include some premium increases for higher earners for Part B coverage, the non-hospital part of Medicare, in the recent changes in Medicare law.

Alper's proposal also deserves serious attention because of who wouldn't want it under any circumstances: the Left. At first this might seem counterintuitive.

After all, aren't leftist liberals at their happiest when "progressively" soaking everybody? Yes, at least those in the "Equality uber Alles" crowd, those who desire to force the American people into a "single payer" system where everybody ostensibly gets exactly the same treatment, namely, what the government decides to give you.

Of course, the Left doesn't argue it this way. By their reckoning, absolute equality will cause the nation to demand ever-higher levels of treatment, which the politicians and the bureaucrats will of course be happy to provide.

Donate to JWR

Leaving aside the minor issue of how to pay for providing everything for everybody at the highest possible level of excellence, this argument suggests that the best way to improve things is through lack of competition.

Should you care to watch this principle of non-competitive efficiency in action, just contemplate today's Pentagon or the Post Office in the days before UPS and FedEx brought competition to the parcel part of their business.

But back to Dr. Alper. In an unpublished paper, he notes that general taxes rather than Medicare premiums currently fund most of Part B, the non-hospital part of Medicare. Therefore, the less-affluent elderly and the tax-paying disabled "inappropriately contribute to inheritance protection for the rich." Also, under today's system, current revenues are spent on the elderly, with younger workers also paying for this "inheritance insurance" through the Medicare tax levied on their paychecks.

In other words, the current system helps the rich stay rich at the same time it makes the poor poorer.

Hoover economist Thomas Macurdy, writes Dr. Alper, "believes that some form of means testing is inevitable if the program is to stay solvent and within the financial reach of its recipients."

Under Alper's proposal, the extra charges would apply only for care actually received. One payment option would a life-long loan paid off by the estate of Medicare recipients after death. This would protect seniors' way of life.

This is an intriguing idea that would buy some time for Medicare, giving an opportunity for attitudes about Medicare and health care to change while the implications of the health savings account (HSA) provision of the new law sink in. [See: Silver Lining in the Medicare Clouds?<]

As Alper writes, in a different context, "The answer does not lie in more rules and regulations and more interference with the freedom of both doctors and patients to do what they think best."

With such changes, additional reforms allowing enhanced individual choice and responsibility for both patients and doctors could again be taken seriously. Partially "opting out" of the system would likely be more acceptable, in contrast with the current "all or none" strictures on participation in Medicare.

True, there is always some risk in any change; in this case, legions of bureaucrats would have to write regulations implementing such changes, adding to the already impossible burden of compliance.

And it doesn't take prophetic abilities to know that legions of civil lawyers would descend on the whole "loan good until death" system; that endless loopholes and endless lawsuits would trash the equity as well as the idea.

But now that the bulwark of the "one size fits all" entitlement mentality has been breached, this idea deserves serious consideration.

Editor's Note: Robert J. Cihak wrote this week's column.

Michael Arnold Glueck, M.D., is a multiple award winning writer who comments on medical-legal issues. Robert J. Cihak, M.D., is a Discovery Institute Senior Fellow and a past president of the Association of American Physicians and Surgeons. Both JWR contributors are Harvard trained diagnostic radiologists. Comment by clicking here.


12/19/03: Crossing Fruit Street: Some Movies Like "Stuck on You" Cross the Medical Line
12/12/03: Silver Lining in the Medicare Clouds?
12/05/03: Medicare mop up
12/01/03: The Dirty Radioactive Bomb: Rational Response or Fear Itself?
11/24/03: The Caduceus Conspiracy: How the People Lost Medicine and How We Can Take It Back
11/14/03: Mosquitoes kill us; DDT doesn't
11/07/03: Avoiding the Schiavo Scenario: Readers Speak Out With Life-and-Death Comments
10/31/03: The Terri Schindler-Schiavo Case: Speaking out for those who can't
10/24/03: Want health service — go on a diet?
10/15/03: The War on Legal Painkillers: Sen. Kerry owes an apology to the more than 48 million Americans who suffer chronic pain
10/13/03: Medicare defrauds itself
09/19/03: Politics prevents women from learning about abortion/breast cancer risks
09/12/03: Medical mischief
09/05/03: Unholy medicine
08/29/03: The California Tea Party and West Coast Determinism; Voter anger coming your way soon
08/18/03: The outlaw prosecutors: A Justice and Civil Liberties Issue
08/08/03: "Toxic Teeth?"
07/25/03: Resuscitating the Constitution; CPR American Style
07/25/03: Drug reimportation: Bill translates to goodnight, patients
07/11/03: Costly Medicare Changes, Without Real Reform
07/04/03: The Painful DEA II: War on legal drugs ensnares too many doctors and not enough dealers
06/20/03: The Medicare Mess: Will President Bush call Congress' Bluff?
06/13/03: Diagnosis: School Insanity: A suit for sanity and school discipline
06/05/03: Soaring Medical Costs: Rational ignorance or rational enlightenment?
05/30/03: A Tale of Two Admirable Women: Jessica and Annika
05/23/03: Latest medical innovation: Cash
05/09/03: We feel your pain; Physicians have it too no thanks to the DEA
05/02/03: Medical Quarterbacking
04/25/03: CNN the "Conscience-Not Network"
04/21/03: Medical Miranda?
04/11/03: Are childhood vaccines shots in the dark?
04/09/03: The PETA Principle -- The lambshank Redemption
03/28/03: American conscience?
03/21/03: West Wimps or Wings: Treatment for Hollywood Hypocrisy
03/13/03: Worldwide schmaltz shortage looms --- all because of a featherless chicken
03/06/03: Legal metastases are killing us
02/28/03: Outside the Jury Box: Seeking Justice rather than a Lottery in Medical Liability
02/21/03: Workforce temperature rising; employer TLC in demand
02/14/03: Malpractice Insurance: They Reap What They Sue
02/12/03: Hawk, Dove or Groundhog: Diagnosis Critical List; Prognosis Uncertain
02/07/03: How about tax cuts for the "rich" and "poor"?
01/31/03: AIDS Bug Chasers
01/24/03: Libertarian moment or movement?
01/17/03: It's not just 'sue the docs' anymore
01/03/03: A pox on the critics; diagnosis sour grapes
01/03/03: If protesting is good for your health; then at least let's root for the home team
12/20/02: Obesidemic (obesity epidemic) or not?
12/20/02: Time for voluntary informed smallpox vaccinations
12/13/02: The real reason the state opposes homeschooling?
12/06/02: Conscience of a former conservative: Portrait of a political metamorphosis
11/27/02: Thanksgiving dinner hazard?
11/22/02: Time to think outside the box and inside the nucleus
11/15/02: The military should be protected from abusive environmental laws in times of war
11/11/02: Does Kyoto Treaty pose more harm than global warming?
10/31/02: Deep thoughts on Baseball, the World Series and Life: How about them Anaheim Angels?
10/23/02: "Pediatric rule" guinea pigs
10/23/02: Once the World Series ends, we need to create a Donnie Moore Day of Remembrance: Sports and mental health
10/18/02: Congress to senior patients: Do as we say not as we do for ourselves
10/11/02: Using pollution "scare labeling" to political advantage
10/04/02: The Great Asbestos Heist: Did Litigation and Junk Medical Science Helped Bring Down the World Trade Center?
09/27/02: The imminent rise of civic feminism: A far healthier national alternative in war and peace
09/20/02: A Ray A Day" to replace the daily apple?
09/13/02: Beware of celebrities hawking drugs
09/06/02: Avoid 9/11 overdose: Give blood to begin "September of Service," SOS
08/28/02: From Doubleday to strikeday: Baseball's collective anxiety attack
08/23/02: Should she or shouldn't she?: An alternative view on treating menopause with HRT
08/16/02: Cooking up defenses against germ warfare
08/02/02: Medicine, crime and canines
07/26/02: Lies, pathologic lies and the Palestinians
07/19/02: Medicare Drug Follies as in "now you see it, now you don't"
07/12/02: Anti-Profiling: A New Medically False Belief System
07/08/02: Don't procrastinate, vaccinate!
06/28/02: The scientific advances on the safe and effective deployment of DDT are being ignored, or denied. Why?
06/21/02: Sex and the system: In seeking healthcare men are different from women
06/14/02: The FDA, drug companies and life-saving drugs: Who's the fox and who's the hen now?
06/07/02: Medical Privacy Lost: A hippo on the healthcare back!
05/24/02: To clean up America's game: A (soggy) ground rule
05/10/02: Free speech is good medicine
05/03/02: Medicine's Vietnam
04/26/02: Attack on alternative medicine could lead to alternative lawsuits
04/12/02: Insure the 'crazies'?
04/09/02: No Time for Litmus Tests: In War We Need a Surgeon General and NIH, CDC, and FDA Directors
04/02/02: The scoop on soot: A dirty rotten shame?
03/22/02: Too many beautiful minds to waste: The first annual Caduceus Movie
03/15/02: Terror and transformation: Defense essential for health & state of mind
03/08/02: Diagnosis: Delusional
03/06/02: The great matzah famine
03/01/02: Is new Hippocratic Oath hypocritical?
02/15/02: Why the recent moaning about cloning?
02/08/02: Searching for Dr. Strangelove
01/15/02: Score one for the value of human life
01/04/02: Medical-legal-financial wake-up call
12/28/01: Who's afraid of a 'dirty bomb'?
12/21/01: End of medicine?
12/14/01: More heroes: Docs deserve a little credit after 9/11
11/16/01: Do we need 'Super Smallpox Saturdays'?
11/09/01: Why the post-9-11 health care debate will never be the same
11/01/01: Common sense good for our mental health
10/26/01: Your right to medical privacy --- even in terror time
10/12/01: Failed immigration policy ultimately bad for nation's mental health: Enemy within leads to epidemic of jumpy nerves
09/28/01: Can legal leopards change their spots: A treat instead of a trick
09/21/01: Civil defense again a civic duty
08/30/01: Shut down this government CAFE
08/23/01: School Bells or Jail Cells?
08/15/01: Time to take coaches to the woodshed
08/10/01: Blood, Guts & Glory: The Stem of the Stem Cell controversy

© 2002