I started reading Byron Farwell's essay [1] with the hope of finding ways to more compassionately care for my patients, but by the end of the essay I had even greater concern about the growing irresponsibility of the elderly.

Mr. Farwell, in the 30 years since you were sipping cognac during your hospitalization and surgery, much has happened to the financing of health care in the United States. This has primarily been brought on by the unwillingness of the Medicare population to pay for even part of their health care. The care you received during your hospitalization may have been impersonal, but this is because the person receiving the care is no longer paying for it.

With Medicare and a supplement or, even more alarmingly, a Medicare-contracted health maintenance organization, the out-of-pocket cost to Medicare patients is essentially zero. You are effectively eliminated as a consumer of health care and have transferred this responsibility to the government or a corporation. While health care quality has decreased and profit margins have tightened, the Medicare population has resisted even a minor increase in their financial responsibility for the services they receive.

More to the point, the hospital was paid at a diagnosis-related group (DRG) rate by Medicare. This system pays according to diagnoses documented in the chart, which are discerned by a coder in the medical records department. The price of the pills that you so loudly protest were included in the DRG payment. The hospital receives neither more nor less money based on the amount of care they provide. Their financial incentive is to constrain costs by providing less care per diagnosis.

The next time you sit by your fireplace with your large drink contemplating your health care needs, consider this. You have lost the opportunity to vote with your wallet. I must admit it has its advantages, but, as you can see, over time it certainly has corrupted the system for the worse. I would urge you and your generation to stand up to the progressive bastardization of health care that is ongoing in the United States. Remember, you get what you pay for.