Telemedicine, Medicare and Moral Obligations

When President Lyndon Johnson signed Medicare into law in 1965, the average life expectancy of Americans was 70. Many of the 19 million people who signed up for Medicare during that first year didn’t make it to their 70th birthday. The Medicare budget was about $10 billion.

Over time, Congress increased the patient populations eligible for coverage to those under 65 with long-term disabilities, individuals with end-stage renal disease, hospice patients, and Americans younger than 65 with amyotrophic lateral sclerosis (known as Lou Gehrig Disease). At the same time, advancements in healthcare began reducing mortality in older age.

Fast forward to the present day. Medicare coverage now extends to some 50 million people, and the U.S. life expectancy is 79. And the $10 billion to run Medicare 50 years ago? Today’s tab is almost 60 times larger - $591 billion as of 2015.

It’s no mystery why. Americans live into their 70s and 80s now – and the elderly consume 30% to 40% of healthcare resources.

Last week I was talking to a medical specialist about the proposals aimed at cutting costs. In basic and cynical terms, he said the most cost-effective event possible is sudden cardiac death, especially at age 64 to completely prevent Medicare expenditures. The specialist said very few medical preventions can potentially be cost saving. Only a few chronic life-long diseases do NOT affect mortality, and those don’t include cancer, diabetes, hypertension, hyperlipidemia, asthma or COPD.

Healthcare screenings for prostate cancer and mammograms don’t save money, but we generally ignore the cost – because they can save lives. Taking the financial benefits vs. cost to society argument to its extreme could bring us to an inevitable and rather disgusting conclusion: wealthier members of society who pay a higher share of taxes benefit more than those without the financial means to afford healthcare procedures. Most people agree this invalidates the financial benefit vs. cost measure equation when it comes to health service necessity.

Telemedicine means faster access to services, which can improve the delivery of healthcare – but the specialist said it’s extremely unlikely that it will save federal dollars. He believes the telemedicine industry should focus on improvement of the efficiency of healthcare delivery and specific outcomes, like reducing the length of stay in the hospital and shortening the time gap between the onset of symptoms and diagnosis. He points out that we do not save money when we need to build better bridges, or to have better police enforcement, or to develop better weapons for the military.

Speaker Paul Ryan told Scott Pelley on CBS 60 Minutes that unless Congress fixes it Medicare will go broke in ten years. And President Trump has made repeal and replacement of Obamacare a priority while maintaining the quality of care. Cost savings are important – but as the specialist warned, efforts that focus only on cost savings in either program may overshadow the moral obligation doctors have for their patients and the very purpose of providing medical care.

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