“We’re talking about a sicker problem that’s also more financially troubled,” Osborn says. “The two together are a really bad combination.”
Jordan Grumet, MD, an internal medicine practitioner in Evanston, IL who sees nursing home patients in multiple places and author of I Am Your Doctor: And This Is My Humble Opinion, says the thing that stood out the most to him in the survey was the fact that such a large percentage of older Americans can’t manage the cost of their medical care.
“The wealth in this country is spread diametrically from the very, very rich to everyone else,” Grumet says. “We have an incredibly expensive healthcare system. In Canada and parts of Europe, profits are not the goal for the healthcare system, even if you have an economically diverse strata of classes.”
The economic challenges in the survey point to the problems of out-of-cost sharing and co-pays of Medicare, even though Medicare is a universal benefit, Osborn says. “That may not always be apparent to doctors who are caring for the elderly,” Osborn adds.
Grumet says that most primary care doctors are immensely overwhelmed. “I think most primary care doctors feel like they’re drowning as it is,” Grumet says. “I don’t think American physicians are trained worse, but the pressures on the American healthcare system are different. I love to compare (the American healthcare system) to conducting an orchestra. The way in our healthcare system is to make our conductor also the guy who is taking tickets at the front door. You can’t do it all. Practicing medicine is hard enough, taking care of your patients, motivating them and monitoring their medicine and getting them to do things that are good for them is a momentous problem on its own.”
Everything gets exacerbated by compliance requirements and paperwork, Grumet says. “Twenty-five percent of our time is spent on patient care, 75 percent is paperwork,” he says. “Residents in hospitals spend 5 to 10 percent of their time seeing patients, the other time is charting. The cost of compliance is insufferable.”