medicare


Palliative Care – Not Just for the Dying

I used to think that palliative care was just for people who were dying. Then I found out—about a dozen years ago—that palliative care had expanded its original focus on end-stage cancer patients to include people with serious illness throughout the course of their disease (or diseases). Palliative care, I realized, is far more than […]

Re-Designing Medicare

Under the headline “Greedy Geezers,” the cover of the March 28, 1988 issue of the New Republic shows a phalanx of angry over 65ers surging forward, toting golf clubs and fishing rods. The accompanying article by Henry Fairlie, 64 at the time, excoriated over 65ers as being out for themselves and ready to bankrupt the […]

Who’s Responsible for Granny?

On July 30, 1965, when President Lyndon B. Johnson signed the bill that created Medicare, he outlined an ethical vision for the nation’s obligations to its older citizens. “No longer will older Americans be denied the healing miracle of modern medicine,” he said. “No longer will illness crush and destroy the savings that they have […]

See, Hear, and Speak no Evil in Medicare

Although I was very grateful that Medicare was available when I retired two years ago, I’ve also been surprised and concerned about some of what it doesn’t cover. These concerns are especially in the areas of our eyes, ears, and mouth.  For my mouth, the timing could not have been worse. I had excellent dental […]

The Medicare Social Club

Days from her 80th birthday, “Nancy” (not her real name) is doing well.  She’s active, exercises, drives, travels, and lives alone in a multi-story apartment building without an elevator.  Her busy schedule of weekly activities includes several appointments with physicians.  Nancy’s medical needs are covered by Medicare. Nancy’s been in psychotherapy for a half-century.  She’s […]

Avoiding Futile Care and Reducing Medicare Costs

If we in the U.S. ever hope to get a grip on Medicare costs, our society will first have to navigate a steep learning curve. That’s the lesson to take from three recent publications.  Despite the fact that Medicare is expected to represent 18% of the federal budget in 2020 (up from 15% in 2010), […]

No Sense, Lots of Dollars

Twenty-five years ago, discussions of medical futility were the rage in bioethics circles. The discussions petered out when it became clear that futility was in the eye of the beholder: physicians and patients often had very different ideas about what futility meant, depending on what they hoped medical treatment would accomplish.     In one […]

How Patients Can Assess the Quality of Their Outpatient Care

Even before I launched my geriatric consultation practice, I found myself often poring over another doctor’s outpatient notes, trying to explain to a patient what the other doctor was doing. Not every patient had questions and concerns about what their other healthcare providers were saying, and doing, but a fair number of them did. And […]

A Proposal That Just Might Solve the Primary Care Crisis: Meet the 35 Hour Work Week

In March, The Health Care Blog published a truly outstanding commentary by Jeff Goldsmith, on why practice redesign isn’t going to solve the primary care shortage. In the post, Goldsmith explains why a proposed model of high-volume primary care practice — having docs see even more patients per day, and grouping them in pods — […]

Setting Generational Priorities

In the mid-1980s, just as I was becoming interested in health care for the elderly and the future of Medicare, Samuel Preston, a distinguished social scientist at the University of Pennsylvania, give a 1984 presidential address to the Population Association of America. His topic was the growing disparity between health and other resources for children […]