Your stories are very revealing regarding the silly rules we are forced to get around or abide by in medicine. I’m not sure they have anything to do with the hospitalist movement – I’m sure hospitalists also don’t like these rules.

And Medicare is the biggest driver of silly rules in this setting. I spend 50% of my time seeing hospital patients (as a neurologist) and I am astounded at how inane the rules are. Ultimately the rules are designed, not to improve patient care, but to cut costs. And, of course, Medicare NEEDS to cut costs – since that program alone will bankrupt the entire country very soon. What is the answer?

The ‘answer’ is that we should have never had Medicare in the first place! This ‘free’ health care buffet for the elderly has soured into a stale stew of rigid rules and uncaring bureaucrats. It has poisoned the whole hospital system. While no one can comprehend the rules, physicians can be jailed for inadvertently violating them. As costs go up, further and further rationing (by rules) will be put into place. There is already a form of rationing occurring at the outpatient level: many physicians are simply not accepting new Medicare patients, since the payments don’t cover their costs. At the same time, a real market for health insurance for the elderly has been undercut by low prices charged to enroll in Medicare. Somehow Americans have been duped into thinking that if socialist ideas are implemented in this country, it wouldn’t necessarily lead to typical socialist outcomes!

So what CAN be done! The answer you never hear, that you need to hear, is to slowly phase out Medicare. One option is to increase the age of eligibility for Medicare by one year, for every two years that passes. In this way, gradually fewer and fewer people will be eligible and a health insurance market will slowly replace Medicare.

Is it fair that so many of us have paid into this ponzi scheme and won’t be getting anything back? No, but such is the outcome of all ponzi schemes. It is better than the collapse of an entire country as our reminder that socialism just doesn’t work.