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Sunday, January 1, 2012

Seniors for Fair Medicare Reform

I started my first blog - health care organizational ethics - in August 2007. Here's how I described why I was doing it:
Medical ethics has traditionally focused on the individual patient, the individual doctor, and the patient-doctor relationship. But today most care occurs in organizational settings – group practices, HMOs, VA and more. Insurers and other third parties have a huge influence on the exam room. Medicare shapes care for the elderly and disabled. Medicaid does the same for the poor. Hospital cultures and policies affect what sick patients experience, for both better and worse.

All this means that the ethical quality of health care is profoundly influenced by the ethics of organizations. We can’t have ethical health care without ethical organizations.

Organizational ethics is what this blog is all about.
But my 2007 rationale for the "health care organizational ethics" blog overlooked a major problem. Organizations like hospitals and medical practices live in a mega-organization - the disastrously dysfunctional U.S. political system. With regard to Medicare, the "death panel" lies during the health reform "debate" and Republican refusal to confirm Don Berwick as CMS administrator showed just how toxic our political culture has become. This new blog will include politics.

Medicare has been called the third rail of politics. If you touch it, you're done for. A recent AARP advertisement, directed to the ill-fated "super Committee" reinforced the point. It shows an army of folks around my age marching and looking tough, while the narrator/leader intones:
"Washington, before you even think about cutting my Medicare's a number you should remember - 50 million. We are 50 million seniors who earned our benefits, and you will be hearing from us, today, and on election day."
Here's what I thought an ethically grounded ad would have said:
"Washington, before you even think about cutting Medicare benefits, think about fairness. We 50 million seniors want to do our part to ensure a healthy future for America. We know that for that to happen, Medicare has to cost less. But we want to be part of a team, and that means everyone sharing the burden, including adding new revenues..."
I don't think politicians will get creative about Medicare until Medicare beneficiaries push them. So far there's been no voice from the many seniors who want to improve the care provided under Medicare and, at the same time, to reduce the costs. We're concerned about ourselves, but whether or not we have children and grandchildren we're also concerned about the health of future generations.

I'm insured through my employer, but I'm Medicare eligible. When I'm insured through Medicare, please tell me to wash my mouth out with soap if I call it "my Medicare." It's not just "mine," it's "ours." My payments into the Medicare fund from 1965 on paid for the care of my elders, including my parents. When I'm a beneficiary, my care will be paid for by the younger generation. Medicare is a matter of communal responsibility, not the private property of the 65+ generation.

Age is supposed to be a source of wisdom. Calling for teamwork and shared sacrifice is what my generation should be advocating for. The AARP advertisement invites definition of us seniors as "greedy geezers." I'm hoping this new "Seniors for Medicare Reform" blog will contribute to developing a strong voice from seniors on behalf of a more clinically sound, ethically justifiable, and fiscally prudent Medicare program.


  1. Great proposition - what does "teamwork and shared sacrifice" look like?

  2. Hi Martha -

    It's a privilege to have you visit this new venture. I'm a great fan of the work you and your colleagues do at WBUR.

    "Teamwork" is the key concept. When medical care is going right, patient and physician work as a team, identifying the patient's goals, the options, and factors like cost and convenience. In my own experience in both roles, it's pretty obvious when the collaboration is going well.

    I believe there's a parallel in the relationship between health organizations (like Harvard Vanguard, where I practiced for 35 years) and the population of patients the organization cares for. Physicians understand they must care for a population with the available budget. Patients understand that for that reason it's right for clinicians to consider cost effectiveness - that it would be unethical for them not to do so.

    In my practice experience, Medicare age folks understood this better than my younger patients. That's why I'm trying to encourage a voice for this kind of solidarity from my generation.