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Commentary Author: Jane M. Orient, M.D. Last Updated: Sep 7, 2017 - 10:06:33 PM

The Truth About 'Medicare As We Know It'

By Jane M. Orient, M.D.
Jun 4, 2012 - 11:31:41 AM

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( - Since 1970, government spending on healthcare has increased 5,400%. This cannot be sustained. It is also absolutely certain that Medicare as we know it will end. Politicians are just maneuvering to find ways to fix the blame on the other Party.

If anyone proposes a substantial reform to Medicare, you can be sure that demagogues will immediately wail that it will end “Medicare as we know it.”

It is also absolutely certain that Medicare as we know it will end. Politicians are just maneuvering to find ways to fix the blame on the other Party.

The end of “something as we know it” is not necessarily a bad thing. Try substituting “slavery” or “warfare” or “poverty” for the “something.”

Ending a “popular program that relieves people of their fears of medical bankruptcy” sounds really bad. Ending “socialized medicine for the elderly,” or “a PAC-man-like program that will devour the whole economy,” or “death panels” might sound like a good idea.

The current healthcare debate is aptly described by Congressman Paul Broun (R-Ga.) as the “four D’s:” deny, delay, destroy, and demonize. And the guilty parties are not all Democrats.

I have yet to hear any politician mention the unfunded liabilities of Medicare: the more than $50 trillion in promises that have been made with no way to pay for them. That’s Denial with a capital “D.” “Asking the rich to pay a little more,” or to pay “their fair share” wouldn’t be enough. Confiscating all the wealth in the U.S. wouldn’t be enough.

Delay, or “kicking the can down the road,” occurs predictably every time the increasingly draconian cut in physicians’ fees is due under the Clinton-Gingrich “sustained growth rate” (SGR) formula.

The “destroy” part started in 1966, with the cancellation of the private medical insurance policies held by a significant part of the elderly population. Today, independent doctors are being driven out of practice at a rapid rate, which can only accelerate with the costly compliance demands of the Affordable Care Act (ACA). Some sell out to hospitals; some just retire. Serious shortages are occurring already, even for very basic drugs like anesthetics or anti-nausea drugs, not to mention chemotherapy agents. Research and development will be enormously constrained by the medical device tax in the ACA.

Reformers like Paul Ryan are demonized in attack ads, for example, showing him pushing Grandma over the cliff. Insurers are demonized for the rate increases that unavoidably result from expensive government mandates. Doctors are demonized for causing “waste, fraud, and abuse,” as bounty-hunting auditors or even armed SWAT teams invade their offices.

Europeans and Canadians worry about “patients dying in the streets, like in the U.S.,” if medicine is privatized. Where are those deaths? Where were they in 1965? There were none.

The most likely cause of death in the streets is rioting, caused by unemployment, economic depression, and withdrawal of benefits that people have come to depend on.

With national health insurance, patients still die: On the waiting list. At home when denied treatment that is available in the U.S. In the corridor of the emergency department when there are no hospital beds.

Medicare beneficiaries will die sooner in the U.S. also. Hospitals may punish physicians who transfer patients out to get better treatment elsewhere. Patients may get “terminal sedation” because Medicare punishes hospitals if patients are discharged and readmitted, but not if they die. Comparative effectiveness research may show that the “red pill or the blue pill” sometimes works almost as well as aggressive treatment, and at a fraction of the cost. Aggressive treatment may only help a minority of patients, so everybody gets the same ineffective pill.

Since 1970, government spending on healthcare has increased 5,400%. This cannot be sustained. So we are faced with a choice.

We can continue the 4-D policy and keep inflating the healthcare balloon until it bursts, and Medicare crashes and burns. Or we can allow people the freedom to choose a private alternative, in which case Medicare as we know it will end by attrition, as Americans find a better, voluntary way.


AAPS was founded in 1943 to fight against a government takeover of medicine.

About the author/contributor:

Jane M. Orient, M.D., Executive Director of Association of American Physicians and Surgeons, has been in solo practice of general internal medicine since 1981 and is a clinical lecturer in medicine at the University Of Arizona College Of Medicine. She received her undergraduate degrees in chemistry and mathematics from the University of Arizona, and her M.D. from Columbia University College of Physicians and Surgeons. She is the author of Sapira’s Art and Science of Bedside Diagnosis; the fourth edition has just been published by Lippincott, Williams & Wilkins. She also authored YOUR Doctor Is Not In: Healthy Skepticism about National Health Care, published by Crown. She is the executive director of the Association of American Physicians and Surgeons, a voice for patients’ and physicians’ independence since 1943. Complete curriculum vitae posted at Additional information on health-related issues: and

Dr. Orient’s position on Obama’s healthcare reform: “The Obama plan will increase individual health insurance costs, and if the federal government puts price controls on the premiums, the companies will simply have to go out of business. The plan will deliver higher costs, more hassles, fewer choices, less innovation, and less patient care.”

Additional links:

AAPS on Fox News Channel:
Obama’s poor Julia:


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