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.