Medicare,The AARP, and Sutton’s Law

There was a time when Sutton’s law was commonly taught to medical students, but its use has declined as has the notoriety of the bank robber (Willie Sutton) for whom it was named. Sutton is alleged to have said that he robbed banks because that’s where the money is; he denied saying this. It’s meaning is that you should work on the part of the problem that’s most likely to give you the results you’re after instead of wasting time and money on the periphery.

The AARP seems to be ignorant of this basic principle of action and interest. They just sent out a mailing urging their members to contact their Senators to support healthcare reform.  They want “Congress to ensure all Americans have access to quality, affordable health coverage by:”

1. Providing more prescription drug coverage to millions of Medicare beneficiaries by narrowing or closing the benefits coverage “gap” (or Doughnut Hole) in the Medicare Part D program;

2. Ensuring all people have a choice of health care plans they can afford regardless of age or any pre-existing health conditions;

3. Making sure all Americans are free to choose their doctor and to follow the course of treatment their doctor recommends;

4. Strengthening and improving Medicare and ensuring that Americans ages 50 to 64 have a choice of health insurance plans they can afford;

5. Improving quality and reducing medical errors so all Americans have the peace of mind that comes with good health care;

6. Ensuring that all Americans have the security of knowing that if they lose a job or experience life’s other ups and downs, they will be able to get coverage;

7. Reducing the cost of health care by weeding out waste, fraud, abuse and inefficiency that leads to unnecessary and more costly care; and

8. making sure some individuals have a choice to receive the care they need at home rather than in a more costly institution.

That’s some list. I suppose that the AARP thinks its membership is so addled that the won’t be able to see how muddled and utopian the thinking that conceived this list is and that they’ve forgotten who Willie Sutton was. Remember the goal is access to quality and affordable health coverage. If we’re going to save money on medical care we have to go where the money is. It’s not in the Boy Scouts; it’s in Medicare. If the AARP gets its way Medicare recipients are going to get screwed. Consider bullet #7. Where’s the inefficiency and and unnecessary care that’s slated for the trash?

Medicare fraud is already illegal and needs no further legislation. The waste and inefficiency in the system (and there’s a lot of it) is tattooed onto Medicare and is likely to be reduced by no other process than the delivery of less care. If it were relatively easy to discard waste and inefficiency we’d have already done it. It too would require no new laws.

By the way, did you see a bullet advising tort reform? No?  Neither did I. Figure out why yourself.

Consider point #1. It will raise costs. 75% of Medicare recipients had prescription drug coverage before the Part D program was enacted. I suspect many of these seniors will drift out of private programs into the public one as time passes. So we’re going to have to  make up the cost of this part of the plan somewhere else. Of course we could nationalize the pharmaceutical industry. If cars why not drugs?

Point #2 requires (though it avoids saying so) that health insurance be mandatory for everyone. If it were optional healthy people would wait until they got sick to buy insurance. Point #4 is redundant; it duplicates #2. AARP membership starts at age 50 so I guess they thought they’d throw the point in to remind their younger members that they’re thinking of them.

Number 5 is admirable. The medical profession has been trying to do this for generations with some modest success. It would be great to do better but I doubt the Federal government will improve on our efforts.The best way to make no errors is to do nothing.

The last point is interesting. The cost of taking large numbers of patients out of nursing homes and other custodial institutions is difficult to calculate. With all the nursing and ancillary support necessary to do a decent job I suspect costs would go up.

It’s nice to be public spirited, but the AARP seems to desire a plan that will inevitably result in less care for Medicare patients. It may even be better for the country to spend less taking care of the old, but an organization that claims to represent this population should back a plan that preserves their interests. Let some one else lobby for restricting care to the elderly.

The AARP has not officially endorsed a specific piece of legislation, but their points seem to straight out HR 3200. When you look at the totality of their desires you can’t tell if A. Barry Rand the AARP’s CEO whose signature follows these bullets is naive or devious. Nevertheless, he proposes a system that has yet to work anywhere and which is so full of contradictions that even Thomas More couldn’t figure out how to construct it. Regardless, he and anyone else interested in building a medical Utopia should read Isaiah Berlin’s essay The Pursuit of the Ideal. The AARP seems to have become a partisan organization masquerading as an impartial organization devoted to the well being of older Americans. When an organization loses touch with its members it future is ominous.

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