Facilities designer: Medicare is 'the biggest Ponzi scheme of all time'
America is falling victim to the "the biggest Ponzi scheme of all time," according to Marc Sauvé, senior healthcare strategist for Nashville, TN-based architecture firm Gresham, Smith and Partners. And it's not taking place on Wall Street. "Bernie Madoff's got nothing on the Medicare Trust Fund," Sauvé said Wednesday at the Healthcare Facilities Symposium in Chicago, an event that brings together architects, engineers, interior designers, planners, financiers and the occasional hospital CEO. "There's a whole lot of trust and very little funds."
And to be sure, Medicare isn't the only part of the American healthcare system that needs fixing. "I believe we have the best hospitals in the world," said Sauvé, author of This is Not a Drill: The Real Emergency for American Hospitals. "However, we have the worst system" in terms of access, equity and incentives. "You've got to think of your healthcare system as an investment portfolio that needs to be boldly rebalanced from time to time."
Without explicitly endorsing one healthcare reform proposal over another, Sauvé said that Americans needed to get over their stubbornness that has led to advertisements calling for "an American solution" to the healthcare crisis. There are good ideas to be found all over the world. In Canada, for example, all the heavily populated provinces now allow dental hygienists to work without direct supervision by a dentist, a situation that has resulted in the proliferation of walk-in clinics for low-cost, routine cleanings. In this same spirit, America ought to have a system that empowers nurses, physician assistants and other non-doctors to make more decisions, perform more services and, most importantly, speak up when they believe a physician is doing something that could result in a medical error.
Right now is as good a time as any to experiment with new models that encourage quality over volume. "We will only regret what we did not try," Sauvé said.
Comments
By Dr. S. Bala Md | Posted 3:51pm | October 2, 2009
I will not allow any one else but an MD make a decision on health care Rx and management. Teeth are diffrent from health
By Anonymous | Posted 1:35am | October 3, 2009
Equating a dental hygienist with a physician...
The idea that NP and PA's can work equivalent to doctors and somehow improve quality while reducing costs, then being able to judge when physicians are performing in a "substandard" fashion.
My understanding of NP's, reading their literature, is that they have a lot more training so they can practice independently...seems like this logic of this architect (who doesn't actually practice medicine)is that NP's have more education to qualify them to practice medicine, and pass judgement on medical practice, but they don't have as much eduction as physicians, which would make them dangerous...
As a specialty physician, as long as I don't share the risk of these lesser trained folks, fine. I make a lot of money because they order a lot more expensive radiology examinations than do most physicians....a lot more lab...etc. etc.
By Anonymous | Posted 11:40am | October 5, 2009
How many doctors design hosptials? If this is the best the Healthcare Facilities Symposium could pick as a presentor, that explains a great deal. Doctors don't have the time for such nonsense lectures as they are doing VIABLE work. Leave your arm chair opinions for the coffee shop and local op-ed page. Better yet, design something real!
By ktb, RN, Clinical Nurse Specialist | Posted 2:34am | February 23, 2010
By reading your responses, I am uncertain if either of you know what an NP is! There is an obvious lack of understanding regarding the educational preparation of this advanced practice nurse.
NP's are Registered Nurses with Masters or Doctoraldegrees. The first program for training NPs was established in 1965, so their presence is nothing new. What is new is the recognition, based on numerous studies, that they can provide in many cases (and I qualify this by saying not all...) equal to superior patient outcomes when compared to physicians, especially in the primary care arena. There are several physicians in my family, and many of my closest friends are physicians (the result of a 25-year nursing career). I beleive that there is a place for physicians and NP's... both. I would rather see my NP as a primary care practitioner and have a physician remove my appendix- their specialization in skill is highly valued to me and my patients. Read some of the literature out there... it may inform and hopefully change your opinion somewhat.
Grumbach, L., Hart, L. G., Mertz, E., Coffman, J.,
Palazzo, L. (2003). Who is caring for
the underserved? A comparison of
primary care physician and nonphysician
clinicians in California and Washington.
Annals of Family Medicine, 1, 97-
104.
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