A LOOK AT MEDICARE; GOVERNMENTAL REGULATIONS IMPACT MEDICAL COSTS FOR EVERYONE

When you visit your doctor, his or her primary attention is on your health. But the doctor also has a list of concerns in the back of his or her mind that include rising costs, lawsuits and AIDS.

These issues are among topics being discussed at this week's American Medical Association meeting, which Cape Girardeau surgeon, Dr. Melvin C. Kasten, is attending.

Before he left, Kasten commented on some of the issues doctors face.

"Why is the cost of medicine so high? Everybody wants everything," Kasten said.

"Are insurance companies charging too much? Are premiums too high?" Kasten asked. "We don't know if they are making too much money; we can't look at their books."

The federal government, Kasten said, is making inroads on doctors' turf. The government is making decisions about patient care that used to be made by doctors.

"If my patient needs a hernia operation, he has to have it as an outpatient, regardless of his age or health or if he has someone at home to take care of him that night," Kasten said. "We have a real harassment of medicine."

In addition, he said, the government predetermines the cost of medical procedures.

"Medicare only pays what they decide a case is worth."

He said six patients recently were in the hospital. Because of their conditions, they would all remain in the hospital longer than the specified amount of time.

"Their combined hospital bill was $950,000. Medicare paid $90,000," Kasten said. "Hospitals have to absorb that difference."

He said doctors, too, receive set fees from the government regardless of actual costs.

"Illinois public aid generally runs out of money in January and doesn't get any more until July."

"All this makes medical costs higher for everyone."

He said money could also be saved if society changed its priorities about health care for patients who are dying.

"Are we wasting our money when we know the patient is going to die?" he asked. "I don't know.

"But 25 percent of all Medicare dollars are spent in the last week of life. Ten percent is spent the last day," Kasten said. "Relatives want to keep the patient alive as long as possible, but is it worth it?"

Kasten said the Canadian national health care system is often referred to as a model the United States should consider.

He disagrees.

"People say it is good because it doesn't cost anything. Income tax in Canada is 50 percent. They are paying for it.

"There are no research grants in Canada for new equipment or cures. The money is just not there.

"I don't think Americans would like the Canadian system," Kasten said. "If you came to my office today, I might be able to schedule your surgery in six months. Forty percent of all coronary bypass surgeries in our northern states are Canadians. They may be dead before they could be scheduled for surgery in Canada."

Kasten said one way to reduce costs is to lessen the chances of doctors being sued.

"Every case that comes in the door is a potential lawsuit," Kasten said. "I would say 100 percent of doctors face this fear.

"I had a patient who was scheduled for a hernia operation. He wanted a CAT scan. I told him he didn't need a CAT scan for a hernia operation, but he insisted. I went ahead and did the CAT scan because, if I didn't and down the road something went wrong, I would be sued."

In his office, Kasten said, each surgeon pays $35,000 annually in insurance against lawsuits.

Kasten said a possible solution would be to change some of the laws regarding medical practice.

"And don't let lawyers work on a contingency basis. If they win, lawyers take 50 percent. Patients who have a legitimate case don't get the money they deserve."

He said laws could be changed to reduce the number of frivolous lawsuits filed against doctors. "Insurance companies will often settle out of court on lawsuits for $30,000 or $40,000 when they shouldn't because it is less expensive to settle than to take the case to court."

Kasten said physicians, dentists and other professionals face the AIDS issue more and more.

Kasten said doctors with AIDS should let their patients know, but, by the same token, patients with AIDS should tell their doctors or submit to AIDS tests.

"We should be able to test our patients," Kasten said. "We're expected to take care of AIDS patients, and I have. But we cannot test them unless they agree to the test. Those we want to test, say no.

"They are going to find a cure some day," Kasten said. "But, if you can't diagnose the disease, you can't treat the disease."