Medicare’s a Fraud – And I’m the Beneficiary

Somebody else has to pay for the stent placed in one of the arteries of my heart. Apparently that's how Medicare works; it's not a pretty – or sustainable – story.

Two doctors did a great job of threading a catheter from my wrist to my heart, finding the more than 90% blockage of a big artery, puffing out the artery with a balloon, and propping it open with a stent. They worked on me directly for about two hours not including prep work, followup, and explaining to Mary that I was still alive and what they'd done to me. I went home that night; a week later I could jog three times as far as before the operation, hike uphill faster, and in general have much more energy. The only disappointment is that I didn't immediately start winning at racquetball and tennis.

Last week the doctor bill came (haven't received the hospital bill yet). The charge for the two doctors was $9,690, not at all too much from my PoV and in line with what you'd pay lawyers or other highly trained professionals. I only owe $188.77; sounds like a great insurance program until you read on. Turns out Medicare pays just $755.06; the balance of $8746.17 is called "MEDICARE ADJ". In other words, because I'm covered by Medicare, the docs have to forgive most of their bill. What this really means, of course, is that other patients are charged more to make up for what we codgers don't have to pay. Our Medicare premiums don't begin to cover the high cost of treating people in Medicare-eligible age brackets, so all you young people get stuck with the bill. The doctor's list price would be lower if they didn't know that a high percentage of their bills would be "adjusted". Sometimes (NOT in my case) doctors stint on care for those with Medicare coverage because they know they will be grossly underpaid for it.

So government pretends to pay for our medical care with an "insurance" policy and makes us happy by charging us too low a premium for the amount of care we receive. Without ever appearing on the government's books, there is a cost shift to other patients so the cost of medical care for everyone else goes up. When "everyone else" complains that the cost of medical care is too high, government's solution (or at least some politicians' solution) is to say that a Medicare-like program should cover them, too.

But, if everyone is covered by a government program, there'll be no one left to pay the doctors the amount that government shorts them. We'll really have to pay for our care through either taxes or premiums. Either the level of care goes way down, premiums get very high, or we pay lots more taxes; there's no free lunch when there's no one else to pick up the check. Before we extend Medicare, we need to recognize that it is essentially an unsustainable fraud – of which we old people are the beneficiaries.

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