-INTRODUCING-
An Inside Look at Health Care for the Elderly and Medicare
By Andy Lazris, MDby
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Kirkus Reviews
Lazris, a primary care geriatric physician and medical director at facilities for the frail elderly, advocates a minimalist approach to medical intervention for many chronic health problems of advanced age, including dementia. He argues that Medicare’s outdated payment rules and assumptions about life expectancy are financing “an interminable search for eternal life” instead of ensuring that Medicare pays for long-term “palliative” care, ideally at home. With an insider’s view, the author does an excellent job of diagnosing pervasive problems in the Medicare system. A fascinating look at how Medicare must change.
Washington Monthly Book Review
Written by Shannon Brownlee, Vice President Lown Institute, Author of Overtreated
Andy Lazris’s Curing Medicare: One Doctor’s View of How Our Health Care System Is Failing the Elderly and How to Fix It weaves the stories of patients throughout a larger narrative. It is also a cri de coeur from a geriatric specialist who wants desperately to care for his elderly patients with compassion and kindness, but finds himself thwarted at every turn by an overzealous medical culture, irrational regulations, and perverse Medicare payments that too often make sending patients to the hospital the easiest option. Curing Medicare is passionate, smart, and a little terrifying.
Nortin Hadler, MD, MACP, FACOEM. Professor of Medicine, University of North Carolina Chapel Hill.
Author of Rethinking Aging and The Last Well Person.
There is now a sizable choir of American physicians recruited from all corners of the profession whose voices are raised in anguish over the difficulty of practicing medicine according to their conscience. As I’ve said before, they are constrained by a perverse “health care” system that has turned health into a commodity, disease into a product line and doctors into the salesforce. Now Dr. Lazris adds Curing Medicare to the repertoire. It is a compelling lament this is, at once, strident and compassionate. It earns Dr. Lazris a position in the front row of the choir. If only we could fill the pews.
H. Gilbert Welch MD, MPH, Professor of Medicine, Dartmouth Institute for Health Policy & Clinical Practice
Author of Should I be Tested for Cancer? Maybe not and Here’s Why and Overdiagnosed: Making People Sick in the Pursuit of Health.
As a medical student, I was trained in “thorough” – the goal being to find as many problems with my patients as possible. In Curing Medicare, Dr. Lazris seeks to redefine “thorough” – and not simply to humanize our profession, but to protect the elderly from the harms of too much medical care. It is a passionate, but thoughtful, critique of medicine's relentless focus on numbers, unimportant measures of performance, and turning people into patients.
From The Library Journal, Mary Chitty, Cambridge Healthtech
Primary care physician and geriatrician Lazris writes from the trenches about the challenges and disincentives to quality care of frail elderly patients under Medicare. Lazris contends that current Medicare quality measures often lead to overtesting and overtreatment. Evidence-based medicine does not always have sufficient support behind it. Risk-benefit analyses can be confusing and may be overly compelling. We need to learn to give providers, patients, and their families permission to be less aggressive and place greater concentration on quality of life than statistics. A number of books complement this one, including Erik Rifkin and Lazris's Interpreting Health Benefits and Risks, Shannon Brownlee's Overtreated, Atul Gawande's Being Mortal, and Jerome Groopman and Pamela Hartzband's Your Medical Mind: How To Decide What Is Right for You. But changing current practices and attitudes will not come easily or quickly, as such alterations require difficult conversations. VERDICT This title will be of interest to readers who are aging, have aging parents, and/or are concerned about the future of medicine in the United States and the world.
Daniel Becker, MD, MPH, Professor of Medicine and Palliative Care, University of Virginia Medical Center
Director of the Center for Biomedical Ethics and Humanities
Dr. Lazris, a general internist and geriatrician, has written a wise book. All doctors in training and doctors in practice should read it, and so should their patients. Our health system has been slowly but steadily making it hard to be well. Blood pressure is up a little, and we call that hypertension. The good cholesterol is too low and the bad cholesterol is too high, and we call that hypercholesterolemia. The bones of a 65 year old are not that of a 25 year old, and we call that osteopenia or osteoporosis. We continue to recommend annual mammography for breast cancer screening even though the evidence that it saves lives is weak and getting weaker. We treat millions of nearly normal people for marginal gains and at at huge cost. We treat the side effects of medications with more medication.This book is well written, well researched, and makes a strong case that less is more for many of the common conditions and maladies that bring people to doctors. It turn out that the test of time is not only free but also accurate. Organized medicine and academic medicine makes much of evidence based practice. But what happens when the evidence is weak? Read this book and judge for yourself.
Robert M Duggan, MA, MAc., President Emeritus, Maryland University of Integrated Health
Author, Breaking the Iron Triangle of Health Care Costs and Common Sense for the Healing Arts
I recommend Curing Medicare for all patients, politicians, physicians, nurses and health policy thinkers. This is an important book by a very skilled individual. Andy is a published novelist, story teller, wise physician and policy wonk. Somehow this man effectively transforms his frustrations with the Medicare system into wonderfully clear teaching stories and solid policy recommendations.
Phillip Soergel, Ph. D. Chairman and Professor, Department of History, University of Maryland
A trenchant analysis of the ills of the current health care regime for the elderly. Dr. Lazris's message is a timeless one: you're not sick. You're just getting older. It is not, after all, an unusual condition in the scope of human history. Throughout he warns of the perils of too much, too much surgery, too much medicine, and too high an expectation for eternal youth. It's a page turner.
Steven Schimpff, MD, Former CEO University of Maryland Medical Center and Professor of Medicine, University of Maryland.
Author of The Future of Health Care Delivery.
Curing Medicare by Dr Andy Lazris should be a must read by anyone who is over 65 and anyone who has loved ones that are growing older, in other words it is important for most of us to understand what he affords us. Medicare has been a major boon to many elderly individuals but it has some serious deficiencies and it behooves us to understand them. Dr Lazris cares principally for geriatric patients and knows his subject first hand from 25 years of experience. A major point is that it is often best to not diagnose and treat aggressively (or “thoroughly” as he puts it) but to use a more palliative approach. But Medicare in both its payment systems and its regulatory approach essentially dictates aggressive medicine, indicated or not. Whether in the home, an assisted living facility, a nursing home or the hospital, the pressures are for being “thorough”, often to the patients’ detriment if not outright harm. These and other problems are fully presented and discussed in a way that we can all understand and appreciate along with his commonsense recommendations for reforming Medicare.
Bridget Hughes, M.Ac., L. Ac., Author of Unlocking the Heart of Healing
Curing Medicare is at once serious and wise, humorous, and entertaining. There are not many writers who can weave concrete and meaningful data into a book that reads like a juicy suspense flick. Dr. Lazris has skillfully woven data, experience from his medical practice, and real-life patient stories we can all relate to into a call to action to change our broken Medicare system and improve patient quality of life. This riveting book shows Lazris to be a stand-out thought leader in an arena that affects us all: Medicare, over-care, and the disconnect from the peaceful beauty that is possible in the context of aging and death when we don’t clutter up the process with end-of-life heroics. Lazris is a fierce advocate for his patients and for educating health professionals and health consumers alike of the dangers of over-testing and over-treating.