Charles A. Bertrand, M.D., FACP, DIM-CD (Ret.)
Associate Clinical Professor of Medicine at New York Medical College
and at the Medical University of South Carolina


As a practicing physician for many years, I'd like to throw in my two cents on a very complicated and difficult situation. In a short note it's not possible to go into a great degree of detail, but rather I wish to focus on 4 general categories.

Medicare or Not

I would suggest that Medicare be continued and as the backbone of our medical system. It has been with us since the late 1960s and our population is generally familiar with its operation -- rather than starting with a new system, new rules and regulations, new personnel -- in effect, a confusing and expensive situation. Medicare is not perfect, but we can continue to chip away at its problems and it will be improved in the future. As expensive as we may think, it pales in comparison with developing a new system associated with huge costs and glitches. Patients often know the telephone numbers, the complaints to make, the doctors who work with the system etc. etc. --- it takes years to develop such relationships. I know that some people are in favor of change -- and change has three possibilities -- namely better, worse, or ends up much the same. While we cannot accurately predict the outcome of a new system we do know, for sure, that it will be costly. And one thing we do already have in our country is a ton of debt and more cost should be our last choice.

Preventive Medicine

A key feature to be stressed should be preventive medicine and as early as possible: In general, this involves smoking prevention, optimal exercise and weight control. While the first two factors are important and should be strongly supported they are not as easy to control or monitor as weight control. Certainly we should abstain from smoking and have incentives offered for exercise although this may prove difficult to implement. This is true for exercise: patient eg.--" I run 10 miles a day" ... " Oh yeah," says the bureaucrat, "Prove it!" Perhaps the most fertile area is weight control since we have so much to work with in that about half the population of the United States is obese. Most scales are fairly accurate and the actual weight of a subject is easy to verify. And so a vigorous campaign against obesity with strong incentives that may have a greater return per dollar spent (or what ever incentive is used). By doing this there actually can be an incremental return -- less diabetes, fewer heart attacks etc., and the fight against obesity should be started at an early age since there are many teenagers who are overweight -- they exercise less frequently than they should, and spend more time in an inactive mode watching television or using a computer. At the other end of the age spectrum our approach is quite different.

End of Life Period

Many older patients have a living will or some other document involving the use of life-support and other modalities in the case of a severe or prolonged illness, and this is good. Unfortunately, it is not as prevalent as it should be. From the standpoint of health planning this is unfortunate because the use of medical care in the last several months of life is enormous. Naturally, we encourage patients to plan ahead, even though this may be rather depressing to some individuals. When a patient enters a hospital he or she has to sign a lot of forms (even for a blood test). I would ask for one more form (and delete others) which allows the individual to sign off for treatment and also when to end it. This is a very delicate subject and is difficult to address -- especially in a short time frame. For example, an individual may have a severe illness and become" brain dead". What then should be done? I suspect that the bureaucrat would like to consider terminating coverage -- that is, the insurance would be terminated and it would be up to the patient's family or friends to pay the bills. I don't know the full answer to this question but I imagine that the government will conclude that some type of financial/time arrangements have to be made which in effect amounts to "pulling the plug" on the patient.

What other Insurance may be considered ?

The key question is what other types of insurance are available. Home owners may have a form of catastrophic insurance wherein the owner pays a certain amount - eg 50,000 and the insurance policy covers the rest. Or for an automobile deductible type policies are well known: a “fender-bender” might occur and the car owner might have to pay the first $500 or $1000 and the rest is covered by the policy. This type of insurance may well be helpful to some either as part of the Medicare system or as an add-on.

There are other suggestions to be made -- but this represents an early partial input because I do fear that the government's plan will be too complicated and too costly whereas I believe the best approach should be as simple and well-defined as possible.

-----And the Best News ------ No More Trillions to be Spent

The advice provided on this website is intended to be general in nature and should not be relied upon for specific treatment. If you need personal medical attention please contact your physician.

Other of Dr. Bertrand's articles on the heart:

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