Monday, June 18, 2007


The New York Times offered an editorial by David Leonhardt, one of their economic writers, concerning the reason healthcare in this country is so expensive. Here’s his take:

The main reason so many people lack health insurance is because of its cost. And a big reason for that cost is the explosion of expensive, medically questionable care, be it knee replacement, preventive angioplasty or lumbar fusion

The example he cites is of lumbar fusion. Apparently, a tiny town in Idaho accounts for a disproportionate number of spinal fusion surgeries, and that the data on its efficacy is mixed. He also says that it cost Medicare 600 million dollars to provide these surgeries in 2003.

A large number, to be sure. I would note that after this introduction, Mr. Leonhardt abandons the topic of disparate medical procedures and manages to focus on Democratic presidential candidates’ plans for universal health care. I’m not sure why Republican candidates’ policies aren’t mentioned. Must be that ol’ “liberal bias” that seems to land George Bush in the White House every four years like clockwork.

But I digress. I have no idea if lumbar spinal fusion is medically questionable. I have not looked at the data. My personal feeling is that back surgery, in general, has disappointing outcomes. The newest one is “kyphoplasty”, but the data I was shown looked promising, as long as an orthopedist didn’t get greedy and try to do multiple vertebrae.

The point I want to make is that, while there may be too many lumbar fusions, that isn’t the biggest expenditure we should be focusing on. It’s EXPENSIVE ELECTRIC WHEELCAHIRS and other frauds! Consider this quote from a CNN article:

Medicare's 80 percent share for power wheelchairs grew from $22.3 million in 1995 to $663.1 million in 2002. That total already has been surpassed in the first nine months of 2003.

Some of these wheelchairs cost as much as used cars! Should a wheelchair cost so much? Of course not. I mean, a baby stroller is maybe a few hundred dollars. How does a wheelchair cost 5000 dollars? Isn't that what a Segway costs?

And I can’t count how many patients in my resident clinic asked me for a letter so they could get disability. One said to me that she couldn’t do her job because her “feet hurt”. I said “Why don’t you get a job on the phone.” She looked at me like I was crazy and said “Oh, I got schizophrenia, I don’t think so good.”

With so many “hard working” Americans sucking at the teat of Medicare and collecting disability and SSI, no wonder the system is going broke. If some of these deadbeats went to work and stopped defrauding their own government, maybe Mr. Leonhardt wouldn’t have to write this article. Why is so little attention devoted to this topic? I guess because it’s more fashionable to solely blame doctors and hospitals for exploding costs.


Anonymous said...

While I can't argue that's an enormous leap in dollars spent, I think the real question here is not "how much" but "why."

Maybe more people are surviving traumatic injuries that leave them unable to ambulate without a wheelchair. Maybe people are living longer with debilitating conditions that might otherwise leave them bedbound. Maybe some of these are severely disabled kids who would not have survived even a few years ago. Maybe people with disabilities are advocating for themselves more forcefully and are seeking ways to get out and about, socialize, go to work, etc. instead of staying home idle and lonely and bored all day (your schizophrenic example notwithstanding).

If I couldn't walk, I think I would see a motorized wheelchair as a Godsend. I mean, it is a hell of a lot of work to try to propel a wheelchair by hand. Many public places are still not very accessible, and it's demeaning to constantly be forced to ask people for help. For someone who needs a wheelchair, the technology is probably a huge improvement. Unless you don't think the disabled deserve to have any advantages?

Even a basic wheelchair costs a lot of money - more than most average people can afford. Not to mention the fact that many disabled people are employed far beneath their capacity or desire to work and hence can be considered "poor."

No doubt there are some people ripping off the taxpayers for fancy motorized wheelchairs, but I have a hard time envisioning it as an epidemic.

Mike said...

Firstly, we are talking about 1995. This was not a technology that was just invented within the last ten years.

Also, if you read the CNN article I linked to, those wheelchairs from the fraud were going to people who can WALK!

Additionally, the number of people who had these conditions you name did not jump up 2800% in ten years! Not even you could believe such a thing.

Also, so mnay obese patients who COULD benefit from walking (to lose weight and burn some calories) are instead burning ZERO calories and losing ambulating ability by opting for the electric wheelchair, thus lining the pockets of these dealers and manufacturers who are only too happy to encourage them, thus undermining the advice of doctors and weight loss specialists.

Believe me, these companies KNOW they are getting away with murder. Just recently I saw a news item aobut a company that was selling a chair for 17,000 dollars!!! They were going to stop. Guess why? Because Medicare was going to stop reimbursing the wheelchairs to such high value. The company knew the jig was up.

So you can postulate all the theories you want, but eventually you'll acknowledge the truth.. it IS a HUGE problem and its being IGNORED by the press. And why? Becuase this kind of fruad is perpetrated often by the indigent. In small ways, surely,. But it adds up. And medical equipment companies are only too happy to oblige. It isnt just wheelchairs. Its special beds, orthotics, scooters, etc etc.

Happyman said...

what about the "medicare diabetic shoe program"?

with NO GOOD EVIDENCE to support any improvement over a good pair of Nike's, this effectively turned inner city podiatrists into glorified overpaid shoe salesmen.

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