We physicians are not a trade union ("Got a better plan for reducing Medicare costs?" April 5). We have a monopoly on an essential service. As such, we are not permitted to unionize without violating antitrust laws. However, medical practice is voluntary. If pay does not cover costs, especially of massive student loan payback and practice startup costs, there will be less and less access to care. Marylanders should contact their legislators about real tort reform if they expect any reduction in their Medicare costs, as elderly patients and their families expect prompt diagnosis, timely treatment and excellent outcomes regardless of age or prior severe illness. They may sue if there is a bad outcome. There should be a federal award cap for care rendered under Medicare because it is a government program just like veteran care and the Indian health service, where lawsuits are limited.
My own father has dementia now. However, a family member insisted on hospitalizing him. He underwent colonoscopy, endoscopy and bronchoscopy at age 77. These tests make even highly-educated families feel that no stone is left unturned, but at great cost and without changing treatment or prognosis. We must begin the conversation about what care is helpful with increasing age and permit our elder loved ones to decline useless interventions as well as lifesaving ones. We should respect their right to autonomy even as we fear our own mortality.
Dr. Theodore Carl Houk, Lutherville