Health Care Costs and the Elderly


BOB ABERNETHY (Anchor): As the president and Congress wrestle with health care reform, their debate has centered on how to provide health insurance for everyone and how to pay for that. But the president and many others also say the increasing costs of care must come down.

PRESIDENT BARACK OBAMA (at press conference): “We’ve got to change how the health care delivery system works so that doctors are paid for the quality of care, not the quantity of care.”

ABERNETHY: In our special report today, Lucky Severson examines why health care costs are so high in one city—Miami, Florida

JANE STROM: Happy Birthday.

AL (Jane Strom’s father): Thank you.

JANE STROM: Do you know how old you are?

AL: Yeah.

JANE STROM: How old are you?

AL: I don’t know.

JANE STROM: How old are you? You are 90, 90 years old…

LUCKY SEVERSON (Contributing Correspondent): Not long ago, Dr. Joel Strom and his wife, Jane, were so convinced that Jane’s father was close to death, notwithstanding the attention he was receiving from ten specialists, they put him in a hospice, and then he got better.

DR. JOEL STROM (Cardiologist and Professor, University of South Florida Medical School): Part of it was that he had one person who took care of him. They cut out all the referrals because they didn’t expect him to live long, and they cut out all the medicines.

SEVERSON: Dr. Strom is a cardiologist and a professor at the University of South Florida Medical School. Like every doctor we spoke with, Strom is fed up with the health care system.

DR. STROM: It’s not a broken system. There is no system. Medical care is haphazard. Medical care is disorganized. There are pockets of superb care. There are pockets of very mediocre care.

SEVERSON: If Medicare costs are any measure, Miami-Dade County should have the best senior care in the country. The federal health program spends over $16,000 a year per patient. That’s about double the 2006 national average. Brian Keeley is the CEO of Baptist Health South Florida, the largest nonprofit health care system in that part of the state. He says huge Medicare costs do not translate to better health care.

BRIAN KEELEY (CEO, Baptist Health South Florida): We know that more can be injurious to people, and more health care services, more aggressively providing those services, can result in lower levels of care.

SEVERSON: He says there are several factors that bloat health care costs in the Miami area.

KEELEY: There’s a huge imbalance between the number of specialists and primary care physicians, and we have such a high percentage of specialists down over here, they utilize resources more, technology more.

SEVERSON: Dr. Strom, a specialist himself, says one reason there is such a shortage of primary care physicians is that Medicare doesn’t reimburse them enough for patient visits.

DR. STROM: If you spend a lot of time with a patient you will starve to death as a physician because you will only get paid for a certain amount of time. In fact, a lot of physicians will actually steer patients to their offices to have tests performed, because they collect both the professional component, and if they own the equipment, the technical component.

SEVERSON: Dr. Gloria Weinberg is a geriatrician and chair of the department of medicine at Mount Sinai Hospital in Miami Beach. She says when young doctors, fresh out of medical school and burdened with school loans, discover how much less a primary physician earns, they choose a specialty where they can make more money.

DR. GLORIA WEINBERG (Geriatrician and Chair, Department of Medicine, Mount Sinai Medical Center): f you look at the reimbursement, you are going to come away after you pay expenses, if you are lucky, with $40 or $50 an hour. That’s not going to help the youngsters go into a field of medicine and pay off loans and do everything else that needs to be done.

SEVERSON: Here in Miami, a typical senior citizen will see a doctor 106 times during the last 2 years of their lives. Not just one doctor, several—specialists who will then prescribe a battery of expensive tests and procedures: MRIs, ultrasounds, CAT scans, and an astonishing assortment of drugs. It’s because that’s the kind of care patients around here often demand. Dr. Weinberg:

DR. WEINBERG: Patients are very sophisticated. They come, and they say, “I have a headache.” You take a headache history. They are not satisfied if you say, “You don’t need a scan.” They want a scan. If you are pushed, and you are suspicious enough, and perhaps you suggest a CT, which is less expensive than an MR, some of them will come to you and say, “I want an MR. I hear it’s more sensitive.” We have had patients in our center tell us, “If you don’t do what I’m asking I’m going to sue you.”

SEVERSON: The threat of lawsuits forces many doctors to practice defensive medicine, ordering more tests and procedures to protect themselves from being sued. Health care professionals here cited malpractice suits as another factor behind spiraling costs, and Medicare fraud in South Florida, particularly in the home health care industry, has been described as rampant.

KEELEY: The Miami Herald reported about a month ago that the FBI and CMS [Centers for Medicare & Medicaid Services] indicated that fraud was about $2.5 billion per year in Miami-Dade County. That, in and of itself, is a huge, huge difference, comparing our cost structure to the rest of the country.

SEVERSON: About 50 million Americans are uninsured, and that includes 30 percent of the population around Miami. Many of that number are undocumented and in the US illegally. Whatever their status, most who need care end up in a hospital emergency room where, by law, they cannot be refused treatment.

DR. WEINBERG: It’s our ethical responsibility to treat that patient as we would any other. That patient can go down the path of having a cardiac catheterization, ultimately having a pacemaker, a defibrillator at $30,000, ongoing medical care, and then we face the problem, when we discharge the patient, where does the patient get the follow-up care, and the hospital doesn’t get reimbursed for it.

SEVERSON: Perhaps the biggest chunk of Medicare expenditures, something like 30 percent, goes to end-of-life care for aging Americans. Professor Anita Cava directs the University of Miami business ethics program. She says Americans need to rethink the way we look at end-of-life medical care.

PROFESSOR ANITA CAVA (Director, University of Miami Business Ethics Program): I think we in the United States really need to reconsider our relationship with end of life and to realize it’s a natural process and that perhaps ending life in a more humane and comfortable way at home with family, rather than trying to prolong it for another day or week or month, is perhaps the best way to go.

SEVERSON: Joe Gasperovich would take exception to the ethical argument for withholding expensive medical treatment for aging, failing Americans. He was born in 1919 and would prefer to prolong his life as long as possible.

SEVERSON (speaking to Joe Gasperovich): If they say we need to go to a $1,000 CAT scan, is there a point, an age you reach where you should say no, I’ve lived 90 years?

MR. GASPEROVICH: No, I want more.

SEVERSON: You want more years?

MR. GASPEROVICH: Everybody—nobody want to die.

SEVERSON: Dr. Weinberg says the decisions about the ethics of distributive justice for society as a whole are often much more difficult when the doctor is meeting with a patient one-on-one.

DR. WEINBERG: The health care dollars, an inordinate amount, go to taking care of people in the last 6 months of their lives. But how do you know when those last 6 months are? You have a person who has worked all their life, paid taxes, done very well, and now they are 80, and they have a heart attack. That may be the person who lives 10 or 15 more years. Are we going to say no just because of age? That’s a very, very slippery slope.

SEVERSON: There is a huge ethical discussion about who should make these end-of-life decisions—the patient, the family, doctors, the government? Brian Keeley says some decisions are easier to make. For instance, Medicare should only reimburse for treatments and drugs that are known to work.

KEELEY: It ought to be evidence-based. If something is proven not to work, I don’t think the federal government ought to be paying for it. I don’t think anybody ought to be paying for it, except for the private patient.

SEVERSON: Dr. Weinberg says too many patients receive expensive treatments and surgery in their final years that very likely won’t prolong their life.

DR. WEINBERG: So if you have an Alzheimer patient who, your own belief may be, it’s time to let this person go naturally, and the family is telling you, “I’m the surrogate, and I’m insisting that a feeding tube be put in,” you cannot make the decision not to put the feeding tube on your own, even though you think it’s futile care, at least in the state of Florida.

SEVERSON: Dr. Weinberg says her 95- year-old mother has a living will that stipulates she will not be kept alive on a ventilator. Brian Keeley says preparing for end of life is not something that’s culturally accepted in South Florida.

KEELEY: Other parts of the country where people plan for end-of-life care, with the use of hospices and palliative care and what have you—down here there’s less usage for that, so people go to die in the hospitals.

SEVERSON: Everyone seems to agree that health care reform is urgently needed and that health care should be a right and not a privilege and that it should extend to everyone. They also agree that South Florida is a good place to start.

For Religion & Ethics NewsWeekly I’m Lucky Severson in Miami.

  • Brigit Barnes

    This article is unfortunately a repetition of the same superficial coverage the media presents the public. The media fails the public by simply parroting generalities and cliches without any question or exploration. What do we mean by healthcare being a right and not a privilege? If it is a right, shouldn’t an elderly person get the treatment he or she wants without some utilitarian judge denying that care because in that judge’s view, the patient has lived “long enough”? Another example is the parroting of the notion that “more care leads to less quality care”. What does that mean and where is the documentation to support that claim? The public deserves a much more thorough discussion of the health care debate from PBS.

  • Carol Schneider

    How this segment, rang true! I am an RN, who moved to South Florida, two years ago. I previously worked for a hospice, in NE Pa. I have noticed a vast difference, with regard, to end of life issues and the abundance of demands of patients and family members, even when the prognosis is documented as,” Poor, prognosis.”
    We,as society, throughout the US, are in dire need of acceptance of death, as a part of, the life cycle.

  • Donna Eddy

    A response to B. Barnes. the response of #1 is a parroting of those who are against national health care or public option. A recurring theme is that others will decide what care will or will not be given. That will be the government. We have a right to decide for ourselves this theory goes and not have health care options with held. the truth is for a majority of those who have health care they are already experiencing health care being denied. Not extra testing, but life and death treatment with out which the person may die. These have been denied by insurance bureaucrats under the present system. So this argument is not valid. I’d rather the government regulate who using doctors and medical personal decide than an insurance bureaucrat. I did think your piece was good. I do worry that there is a age bias against old people in this country and would want to go slowly here. My mother was on medicare and doctors started treating her differently after her 85th birthday, not even helping her with migranes. It was the doctor’s bias in this case. We changed doctors.

  • John Ryan

    Regarding “Donna E says”: “for a majority of those who have health care they are already experiencing health care being denied”. A MAJORITY? What are the facts upon which you base this?

    If this quote from the program didn’t send a chill down your spine, you must already be dead: “There is a huge ethical discussion about who should make these end-of-life decisions—the patient, the family, doctors, the government? Brian Keeley says some decisions are easier to make. For instance, Medicare should only reimburse for treatments and drugs that are known to work.”- the guy is actually suggesting that the government decide who will live and who will die based on it’s own determination of what “treatments” will “work”. ARE YOU KIDDING ME? These folks haven’t even committed a crime (other than a Washington bureaucrat’s determination that they’ve outlived their usefulness) and they may well face a death sentence. No trial. No appeal. Wake up folks.

    You also conflated private and government systems, missing entirely THE major difference- there is no alternative to change plans in the latter (Big Brother system) vs the former (in which we can almost always change if we so desire).
    It blows my mind that you bring up the bias your 85 y/o grandmother faced and simply recommend they “go slowly here”. GO SLOWLY? Give me a break. How about “I want no part of such bigotry”!
    And make no mistake, the pressure to stop treatment (which by the way in the House Bill defines as including food and water) will begin way before the age 85.
    The piece was ridiculously superficial about an issue that will affect the lives of every single person in the United States.

  • Gman

    Thursday, July 30, 2009
    The Health Care Debate and Tommy Douglas, Greatest Canadian of All Time

    Few Americans may realize that a Baptist minister is recognized by Canadians as the “Greatest Canadian of All Time.” Tommy Douglas, who died in 1986, is one of history’s most influential Baptists that few outside of Canada know. And here in the summer of 2009, Douglas’ legacy is extremely relevant to the biggest issue facing Americans: health care.

    Tommy Douglas, you see, was the man who brought about Canada’s universal public health care system, a health care system which Canadians for several generations now have chosen to pay extra taxes to operate and maintain, and a health care system which 91% of Canadians today view as superior to America’s health care system. Furthermore, Douglas set Canada on the road to universal health care during the Great Depression, while here in America today President Obama is seeking to do the very same thing during the current Great Recession.

    Douglas, a minister turned politician, first became personally aware of the moral imperative of health care when as a child he almost lost his leg to a disease because his family could not pay for treatment; only by the good graces of a doctor, who offered his medical services for free, was Douglas’ leg saved. Influenced by the Christian principles of the Social Gospel while in collge, Douglas pastored for several years before entering politics during the Depression in 1935, becoming the Premier of Saskatchewan in 1942. He remained a leading politician in Canada for many years, consistently advocating for universal health care and basic human rights. Under his leadership, the Saskatchewan Bill of Rights was enacted. And while securing public health care for all citizens, Douglas paid off government debt and created a surplus.

    Although today most Americans want a public health care option, we as a nation are slow to the table in responding to the moral imperative of basic universal public health care (although a number of presidents, beginning with Teddy Roosevelt, have personally supported public health care). If we as a nation this year do manage to place human life above the greed-driven free market health insurance industry by enacting a public health care option, we have Tommy Douglas to thank, one of the greatest Baptists of the past century.
    Posted by Bruce Gourley at 7:00 AM
    Labels: baptist, government, greed, health care, insurance, Teddy Roosevelt, Tommy Douglas

  • Jan

    I hope Professor Cava has a real grip on what it is she is saying. I believe in hospice and advanced directives and that people have a right to refuse treatment in order to focus on dying with respect rather than trying to prolong the inevitable. I DO NOT believe or want the government to address end of life issues in regards to when we should “assist patients” to die at home. That is leaving a great big open window for the Kavorkians of the world to decide to play God. My mother is elderly and she decided a long time ago what she wants. Yes I want her to be comfortable when the time comes and to make the death a more easy process or transition for her. But I do not want government to say to me, “It’s time”. ” We are going to help your mom along by giving her some morphine, paralytics and you need to say your goodbyes.” This is an insane inhumane concept. As for helping people to die more comfortably, we already have that process, it is called hospice.