What Works Better: Bureaucracy or Markets?

Aaron Carroll and Austin Frakt relate the problem:

Over the past decade, the number of reimbursed eyelid-lift procedures has tripled. The cost to taxpayers has quadrupled, to $80 million from $20 million.

Medicare traditionally avoids coverage for cosmetic procedures such as Botox or breast augmentation (except after medically necessary breast removal). So why cover eyelid lifts? It’s possible that more of the elderly are suffering real vision problems in need of corrective surgery.

But is it likely that a disproportionate number of these patients live in one state? More than half of the 20 highest-billing physicians were in Florida, where one doctor submitted for 2,200 eyelid lifts in 2008 alone.

Their solution: better Medicare oversight.

My solution: Get Medicare completely out of the business of eyelid lifts. Let patients pay for all such procedures from their Health Savings Accounts.

Comments (17)

Trackback URL | Comments RSS Feed

  1. Sam says:

    What’s next? face lifts being covered by Medicare?

  2. Sam says:

    What’s next? face lifts being covered by Medicare? People on food stamps getting face lifts? hmm..

    • Nigel says:

      I don’t know… if the majority of people want it to be a benefit of medicare, I don’t see a problem with it.

      • Sam says:

        Well, I am pretty sure the majority of the people would oppose. Maybe there are surveys on this out there already…

  3. Studebaker says:

    The scooter industry based on maximizing revenue against reimbursement formulas. The same is true of durable medical equipment. Apparently, there is a whole host of other areas where providers can scam Medicare.

    • Sam says:

      True. I am scam and corruption is found everywhere as long as we as humans continue acting on some of our “negative” traits. However, it’s true that it becomes even easier to act on these traits through state programs that can’t possible regulate every single case and expose themselves to abuses of their own programs.

    • Craig says:

      So if we were follow Dr. Goodman’s advice and pull Medicare out of those industries, what would happen to the economy in those sectors?

      • John Fembup says:

        “what would happen to the economy in those sectors”

        Well, I suppose they would have to provide a product that people want at a competitive price.

        Maybe they can do that, maybe they can’t.

        If they can’t do that, then wouldn’t taxpayers be entitles to a crystal clear explanation of why they should support those uncompetitive sectors?

  4. Nigel says:

    Why shouldn’t medicare provide eye-lifts?

    • Sam says:

      Well, the simple answer would be that there isn’t a conclusive case of evidence found that tells us that eye-lifts are necessary in some cases for improved vision. If certain isolated cases are proven, then perhaps then it’s justifiable, but we are seeing an increasing trend in eyelids where there is no evidence that it is for the benefit of the person’s vision.

      • Sam says:

        *trend in eye-lifts … bah, excuse all my typos

      • Nigel says:

        Why does it have to help eye-sight for it to be an acceptable part of the program?

        • Sam says:

          Because if it doesn’t, it’s not covering a procedure to improve the function of a malformed body part. Eye-lifts aren’t medically deemed as a “malformed body part,” and therefore it’s actually going against Medicare’s own stipulations. There is a fine line and it just seems this one is very easily crossed.

          “Medicare doesn’t cover cosmetic surgery unless it’s needed because of accidental injury or to improve the function of a malformed body part.”

    • Jacob Duveaux says:

      Well it depends whether or not you believe the governments job is to protect negative right or provide positive rights.

    • Dewaine says:

      Right, Sam. It is about using resources efficiently. Yes, in an ideal world everyone would have eye-lifts, face-lifts, hair transplants, and every other conceivable provision, but when you use something it comes from somewhere else. Providing unnecessary eyelifts diverts valuable resources from more appropriate uses. Now you have resources being taken from a possibly life saving scenario to something that isn’t much more than a cosmetic one.

  5. Dewaine says:

    I agree with Dr. Goodman, having more freedom over your money will push you to use it more responsibly.

  6. Bob Hertz says:

    Although $80 million is a small number in Medicare’s annual spending of $600 billion, waste is waste and should be exposed.

    One solution would be a deductible of $1000 or $2500 across the board in Medicare.

    The deductible would be waived for annual exams and basic screening tests and for emergency care. I am not a master of these details but they can be worked out.

    This will be a hard sell politically, to put it mildly. Both Democrats and Republicans have won entire elections by stirring up fear and anger among seniors.

    I welcome any suggestions for how to get Medicare out of this frivolous spending.