How to make Medicare great again

Unknown to many of our seniors, the original Medicare program recently came out with a new rule stating that Medicare will no longer cover routine blood tests ordered by a doctor as part of a general physical examination or screening. In its place is something called an annual “wellness exam” which pales in comparison and effect.

Since 1965 Medicare has been designed to keep our older Senior population living longer and healthier lives. But program costs have been increasing and so our government set out to see where cuts could be made. Having been involved with a national Medicare service provider in the past, I readily understood the need for changes and supported the effort. However, this recent fundamental change to the original Medicare program is shortsighted and counterproductive. It will ultimately result in higher costs and, more importantly, higher numbers of hospitalizations, longer and more costly treatments and increasing numbers of preventable deaths.

So the blood test I had a few years ago as part of my annual physical exam, which discovered my blood sugar levels were elevated, will no longer be covered by Medi- care. That test alerted my doctor that I was in danger of becoming a Type 2 diabetic unless I quickly adopted some lifestyle changes. High blood sugar levels can damage nerves, blood vessels, the heart and the kidneys.

More than one in four seniors (over age 65) in the U.S. have diabetes and millions more may be pre-diabetic but undiagnosed and unaware of their condition. Blood testing, as has been customary in the past, would point to emerging warning signs for many serious health conditions, as with elevated blood sugars for example, and interventions could be initiated to avoid subsequent costly medical treatments and potential premature deaths. By eliminating annual Medicare blood testing, many seniors will remain unaware of potentially life threatening conditions festering in their bodies.

This recent rule is part of the new set of cost-lowering measures adopted by Medicare under the guise of adding “quality and value” to the Medicare program. Lowering costs is the main underlying motivation. In the past Medicare had utilized a “fee-forservice” approach where doctors and medical providers were compensated by the number of tests and services provided. This obviously provided incentives to overutilize both treatments and tests and raise program costs.

In place of the former annual physical exams, including blood workups and hands-on examinations, original Medicare is now compensating doctors for conducting an annual Wellness exam. This is basically a hands-off discussion between doctor and patient reviewing family history, prescriptions, risk factors, routine measurements, advance care planning, cognitive impairment and preventative services. This could easily be conducted by a physician’s assistant or nurse. Instead the doctor should be examining the patient’s body as he was trained to do. But Medicare won’t pay for that any longer unless the patient complains of symptoms.

I admit to being old fashioned. I want a doctor whom I trust, who knows me, cares about my health and most importantly will use professional skills to prod, poke, listen to my heartbeat, pound on my ribs, and search for troubling signs inside and outside my entire body and then send me out for a blood draw, fecal and urine sample and any other test deemed necessary. The new Medicare program now seems overly focused on cost containment and less on the health of its insureds. Medicare also appears to have little concern that increasing numbers of doctors can’t afford to have many (or any) Medicare patients any longer based on insufficient Medicare provided fees and incentives.

People of means will choose a concierge doctor and pay thousands of dollars annually for those personalized services. Some of us will utilize Kaiser or the senior clinic at Uchealth where the care is quite good, but in a less than desirable clinical setting. And a few of us lucky ones will find an occasional doc who still practices medicine the old-fashioned way in disregard to Medicare’s imposed limitations.

But whatever the choice might be, we need to bring back the “physical” in annual physical exams, including reinstating blood testing, and insist that Medicare includes them as a fundamental benefit in their service package and as a principle way to lower costs, reduce premature suffering and prevent untimely deaths.

Medicare was great before and we can make Medicare great again. Tell your congressman and senators that you need their support.

Dick Wisott is a retired insurance executive and lifelong community volunteer. Contact him at dwisott@comcast.net.