The Two-Tiered System of Hospital Care

Born in Canada, our mother came to the United States after World War II and blended into the Greatest Generation.  Raising a family in the second half of the 20th Century saw her contribute to a thriving American society then maintain retirement health on Medicare.  But in her early 90s, this tranquility was threatened when her HMO hospital tried to kill her.

She went to the emergency room with symptoms of the stomach flu, and ended up rapidly placed on palliative care with an erroneous diagnosis of end-stage liver cancer.  Fortunately, after a long ordeal and because of our medical background, we thwarted hospital personnel efforts and got her back home…healthy.

Because healthcare spending is 17.5% of the nation’s Gross Domestic Product (by far the highest in the world), legislators have focused on lowering this figure.  Some of the financial assault has come against Medicare, creating a two-tiered system endangering the health of the Greatest Generation.  As a primary care physician (PCP), I have seen this onslaught perpetrated against elder senior patients who are admitted to the hospital.

In the Medicare tier, patient reimbursement has been legislatively lowered, and therefore hospital admissions have been statistically scrutinized.  “Length of stay” (LOS) is a common term business-oriented hospital administrators use to bully PCPs to hurriedly discharge still-ill patients to nursing homes.  Multiple case managers and discharge coordinators are employed to hover over doctors expediting “drive-thru” medical care.

Some patients though are extremely ill, and hospitals have maneuvered and exploited end-of-life hospice laws.  Unlike our mother, many patients do not have physician family members guiding them through this ordeal.

In the second tier, those patients who have private insurance and are under 65 do not come under the same scrutiny Medicare patients undergo.  There are no delegated in-hospital oversight personnel, and I rarely receive phone calls from insurance companies to discharge the patient.  Patients stay longer, leave healthier, and there is never a LOS statistical report generated to coerce their PCPs. 

So those elder senior patients — our parents and grandparents, who fought in wars and defended our nation, made it through the Great Depression, and established vested interest in the future of our nation — are swooshed into and out of the hospital in a legally sanctioned attempt to minimize their medical care.

Shouldn’t legislators be more responsible?  Of course, but the caveat to this scheme is Congresspeople making these laws don’t go on Medicare like the rest of us.  They have health insurance outside the Medicare system.  This undermines our ideals of equality, as legislators who make the laws don’t live under the laws.

Not fair?  We have moved forward on many issues, and most of us now believe the Constitution should read “all men, and women, are created equal.”   The same should be said for healthcare.  Let’s get rid of the two-tiered system of hospital care and find a better way to provide Medicare to the Greatest Generation.

For a start, demand all Congresspeople go on Medicare at the age of 65.  They will then have vested interest in their future, as well as ours.

Gene Uzawa Dorio, M.D.


  • Cathy Wentz says:

    I definitely agree that all members of Congress should get Medicare and not some special health insurance policy as part of their retirement. Not to mention, if congressional terms were limited, our legislators would have to go back to their regular lives and livelihoods and the taxpayers could forget paying them huge retirement benefits because they managed to make a career out of being politicians. That could free up some funds.
    Here is another thought as well – I have seen this in various proposals by smart, compassionate people. If seniors of Medicare age were given a reasonable stipend every year for health care, they could use that money to invest in health savings accounts and buy commercial catastrophic insurance of THEIR choice for the more expensive care. This would give them much more control over their own health care spending and they would (hopefully) be treated equally because their insurance would be just like everyone else. The only difference is it would be funded by Medicare (the accumulation of all they had paid into for Social Security and Medicare Part A for so many years.

  • Anne Marie Whalley says:

    I agree with you, all Congress people should go on Medicare at the age of 65. That would be fair, and they would work constantly to make sure that everyone is treated fairly.

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