Medicare as a Form of Entertainment : Health: Government-funded visits to the doctor become tax-subsidized social breaks.

During the five years that my mother lived in a retirement home, I observed that the primary activity and diversion of the residents of these homes is visits to their doctors. Most retirement homes provide free van service to and from the doctors’ offices, and in many cities, senior citizens are able to buy discount coupons that provide nearly free taxi rides. Medicare pays for their doctor visits. Doctors give these old people--many of whose children rarely see them--the kind of concern, attention and physical contact that many elderly people crave.

And that gives rise to a syndrome which, while certainly not universal, seems to me disconcertingly common. Since doctors seldom refuse to see a senior patient who calls for an appointment, Medicare foots the bill for a theme-park entertainment syndrome: the cardiologist/ gastroenterologist/ neurologistroller-coaster ride. Memory tends to fade with age, and an older person isn’t always sure if she saw her doctor a week, a month or a year ago. So why not play it safe and go right now? She doesn’t feel well; the aches are worse. The woman down the hall was rushed off in an ambulance with paramedics at her side this very morning. Better play it safe and call the doctor.

There seems to be no limit to how many times an elderly patient can decide to see his doctor. (Doctors are also required to “take assignment” from Medicare patients and thus are often paid fees far below their regular fee for services.) When the ordinary fears of old age and disability reach a crescendo in the mind of an old person who lives alone, she can so easily pick up the phone and make a doctor’s appointment. Then a day’s activity is set in motion: making the list of complaints to tell the doctor, packing up one’s many medications to show the doctor (at the same time planning to demand more and better medications), getting ready for the trip, taking the ride in the van or taxi, having a guaranteed half-hour’s audience with someone willing to listen, examine, console, advise and encourage. Why not do it two or three times a week?

Once back in the retirement home, after being delivered by the van that is filled with other residents who have just seen their doctors, the residents discuss and plan tomorrow’s activities: making an appointment to see the next doctor.

It’s true that old age is often a balancing act between treatments, medications and therapies, and it becomes a complex and major project for an old person to stay alive and functioning. Perhaps with our Medicare system about to bottom out, the choices for health-care visits should have a ceiling or limit attached to them. The old person’s sudden need to be reassured should not always result in a visit to his doctor, with the bill sent to Medicare.

Perhaps some other feature could exist in the system--a triage or counseling center that could provide some of the assurance, direction and advice that old people require without the repeated full-fledged office visits to full-service doctors that can be repeated without limitation.

And finally, when the only attention available to an old person is bought and paid for by a visit to a doctor, we ought to look to our own futures and think of more satisfying solutions to sustain us in our “golden” years.