Curing Medicare: A Doctor's View on How Our Health Care System Is Failing Older Americans and How We Can Fix It

by Andy Lazris, Shannon Brownlee (Foreword)

Andy Lazris, MD, is a practicing primary care physician who experiences the effects of Medicare policy on a daily basis. As a result, he believes that the way we care for our elderly has taken a wrong turn and that Medicare is complicit in creating the very problems it seeks to solve. Aging is not a disease to be cured; it is a life stage to be lived. Lazris argues that aggressive treatments cannot change that fact but only get in the way and decrease quality of life. Unfortunately, Medicare's payment structure and rules deprive the elderly of the chance to pursue less aggressive care, which often yields the most humane and effective results. Medicare encourages and will pay more readily for hospitalization than for palliative and home care. It encourages and pays for high-tech assaults on disease rather than for the primary care that can make a real difference in the lives of the elderly.

Lazris offers straightforward solutions to ensure Medicare s solvency through sensible cost-effective plans that do not restrict patient choice or negate the doctor-patient relationship. Using both data and personal stories, he shows how Medicare needs to change in structure and purpose as the population ages, the physician pool becomes more specialized, and new medical technology becomes available. Curing Medicare demonstrates which medical interventions (medicines, tests, procedures) work and which can be harmful in many common conditions in the elderly; the harms and benefits of hospitalization; the current culture of long-term care; and how Medicare often promotes care that is ineffective, expensive, and contrary to what many elderly patients and their families really want.

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264 pages, Hardcover

First published September 1, 2014

About the author

Andy Lazris is a physician, historian, and author. He has written numerous books on health care including Curing Medicare, Interpreting Health Benefits and Risks, and Understand COVID-19 Risks.
He has written a fictional account of COVID related to his experience treating COVID patients in long term care, The Geriatrics Vengeance Club in the Era of COVID.
His newest historical fiction books are
Three Brothers from Virginia, an epic novel of the Civil War
Yadel the Dreidel, part one, The Rise of the Zealots, a sweeping, comedic trilogy of Jewish History from the Roman times to the present through my creation, Yadel, who with his friend Clausius, travel the world through infinity.
His email is www.andylazris.com with his blog, videos, and radio shows.

Reviews

[Elyse Walters · Rating 5 out of 5]

I couldn't believe how ENGAGING ....and ENJOYABLE .....this book was to read!
I actually had a dream which woke me up -- vivid as can be -- which I knew instantly came from reading this book.

I don't even know where to start with this review...because first I want to share my
emotions--and how much this book 'calmed' me personally about something
personal which has begun to occupy my thoughts.
Without writing a long story about my own personal history with medical doctors, testing, an autoimmune disease, and the post 'somewhat' traumatic 'exhaustion' from having come through 5 surgeries between my husband and I, just this past year...
( and we are both healthy), I wasn't looking forward to facing the Medicare process. In 2 more years I'll be consider part of the Medicare-Community...( for lack of a better term). I've had friends --( SMART CAPABLE FRIENDS)-- older than me tell me nightmare stories about just trying to figure out how to JOIN THE CLUB! ha! It's very
confusing.

Please forgive me for taking so long to 'review' the book...
but I must share one more VERY IMPORTANT WAKE UP Realization....( for me), that I uncovered reading this.

Not ONLY do I have good medical coverage - ( good old fashion western medicine)...but when my autoimmune disease was at its worse a few years back...I spent money OUT OF POCKET ... ( thousands and thousands of dollars over a 2 year period)...seeing FUNCTIONAL MEDICAL DOCTOR. These type of doctors are KIND...
SWEET... Spend 2 hours with you - order very fancy expensive tests - which get sent to SPECIAL labs ...( looking for more accurate lab ranges than western medicine... Base on HEALTH & VITALITY... not on DISEASE). The idea is they look for POTENTIAL PROBLEMS BEFORE A FULL BLOWN DISEASE DEVELOPS. Sounds, good, right? I thought so, too....
BUT.....here is what DOESN'T feel good. These doctors are 'still' looking for things wrong in the body. They say the purpose is treating the root cause, and treating the
WHOLE person.....
BUT....after following everything BY THE BOOKS... ( hundreds of foods I was supposedly to removed from my diet including TONS of raw fresh veggies), lots of expensive supplements to buy, my MAIN problem never improved. It was only a few years later with a medical doctor in SF - who knew what I was born with ( it's rare)... helped me. ( gave me a cocktail of medicine which seems to be working). Best help to date!

Point is: BOTH NATURAL DOCTORS....and MEDICAL DOCTORS often COME FROM
looking for what's wrong. People go home and worry if they have high blood pressure, for example...( but maybe they don't need to be as concern as they think)
But I tell you --- after reading this book -- I frickin swear to god... It's CRAZY!!!!!!
Worry does not help with the quality of life!!!

Alright, moving on.....
This author, Andy Lazris, is MORE THAN QUALIFIED TO have written this book. He has been a primary care geriatric physician for many years. I love this guy!
TRUE....we don't need to be worried about annual mammograms at 90 years of age.... do we? Family members bring their 90 year old mothers to the doctor expecting 'tests'. Always more 'something'.
We over test people in this county. We ought to be taking the minimalist approach --- ( doctors ought step away from their rigid training and guidelines), and see how they can guide their patients to enjoy the rest of their live). Lazris says we've been too excessive with specialization. He says we need more 'primary' care doctors and LESS specialists. His argument makes sense ..( completely backwards from what I once thought).
The argument is ... why see a primary doctor who only knows a little about a lot of things, when you can see a specialist for a needed problem?
One HUGE problem with this is the specialist could find something wrong WITHIN their specialty...( be completely wrong), and they don't look so special anymore. ---
The book explains things MUCH BETTER than I. I'm just typing away faster than the speed of light ---( forgive the many typos I'm sure I must have)....
but I got value in this book in a DIFFERENT WAY than I did "Being Moral", by Atul Gawande. This book is an EXCELLENT companion....it goes into specifics - and it has stories. ( I of course love the stories)...but the facts are fascinating as well.

The author explains - better than I can write this review of how Medicare MUST change. I didn't even know how it worked NOW???
Let alone change it....( so I REALLY got a double dose of value from this book and it was personal making the reading a pleasure).
He explains about the financing-- where most of the money has been going and changes where we should be spending it. ( re-Organization). He doesn't say it's going to be easy to change the system ... But he DID map out a solution.

One quick warm story... Then I'm out of your hair ( thank you to ANYONE who took the time to read this)... If you didn't read this ...( no problem... this might not be a topic or issue for you)....

Here's just 'one' recap of a story in this book I loved sooo much. ( there are more)

One of Dr. Lazris's patients - an Italian older man who lived in a retirement community
made an unusual ACUTE visit. Dr. Lazris asked his front desk staff why he was coming in.
The front desk staff didn't know.. but told him that it was urgent.
Well, Andy Lazris feared he must have a catastrophic illness. ( this was an elderly man who never complained about anything. But when he arrived he looked terrific.
He said:
"Hey, doc", "I've got heart disease, diabetics, high blood pressure, I pee too much from a big prostate, and my balance isn't worth a damn. You can write all that stuff in your note and bill Medicare for it and say we talked about it. But let me tell you why I am really here. I'm taking a Jewish history class at the community college, which is a great class, but there's a lot of confusing things they talk about for a Catholic liked me, and I know you're Jewish, and you like history, so I was wondering if I could run some stuff by you."
"That was the urgent visit! And both of us enjoyed it very much."
But after their history less, the doctor did ask him some health questions-his expectations for the rest of his life, his exercise regime and family. Andy said he learned more about him during that visit than in all previous encounters.

Thank you to my friends who took the time to read this. I got much value from this book. I'm less concerned about following rules - doing things right...
Although I 'heard' what this great doctor said: "lack of movement and stress
contribute to aging faster than anything else". So... I'll walk - swim- bike -- wiggle & jiggle and be happy!... As for the small stuff - wrinkles, cellulite, loss of muscle mass, dry hair, an older aging body...lucky me....they really are small potatoes!

Thank you Cornell University Press, Netgalley, and Andy Lazris

[JanB · Rating 4 out of 5]

4.5 stars
This is an important book that looks into the medical care and treatment of the elderly. The medicare payment system, the over-specialization of doctors, and the goal of "being thorough" rewards over-treatment, all to an often devastating effect on the elderly. Yet, palliative care is difficult to achieve (and get insurance to pay for) in our current system. The medical model isn't alone in the blame. Patients and their families often insist on the over-treatment.

Old age is inevitable if we're lucky enough to live that long, and most of us will have age-related health challenges. Books like this needs to be part of the conversation, and personal decisions on how to handle this stage of life are best made before it happens. For that reason I think this is a book that should be read by everyone.

The writing style is engaging and conversational in tone and the book is filled with personal anecdotes from the author's medical practice, yet backed up by statistics and research studies to strengthen his position. He's a doctor I would love to have as my own.

** thanks to Netgalley and Cornell University Press for providing me with a free copy of this book in exchange for an honest review

[Peter Tillman · Rating 5 out of 5]

The take-home: Less is more, when it comes to medical care for the elderly. Pretty much required reading for those with aging parents, and those who are getting old themselves.... The author, a geriatric GP, talks mostly about the perils of over-treating frail elders who are reaching (or over) the limits of independent living. Many medications' side-effects outweigh their benefits for frail old people, and admission to hospital may be their death-sentence. Dr. Lazris relates a case early in his career, an active 90-year old farmer with extremely high blood pressure. He prescribed medication, his patient started taking it, and was dead within a week. Dr.Lazris thinks the man had narrowed arteries, and his body was compensating by raising the pressure. When the drug lowered his blood pressure, he died. Oops.

Medicare spends roughly a quarter of its budget on patients in their last year of life—a proportion that has remained steady for decades. "The operations were a success, but the patients died." Medicare spending in 2015 exceeded $600 billion.

So it's pretty obvious there are serious problems here, many relating to top-down, one-size-fits-all Medicare regulations, and this is widely known in the medical business, as a bit of googling will quickly reveal. It's also clear that there are major financial beneficiaries from the high spending: Hospitals, attending physicians, and drug companies. Which suggests why Medicare has been slow to pay for less-expensive palliative and home care for frail old people. Which is what most of the patients actually want. But to get Medicare to pay, they often must go to the hospital, and maybe end their lives in pain and indignity. Catch-22.

Sample chapters and synopsis: http://www.curingmedicare.com/books
Cross-ref to the first edition at Amazon, with 22 customer reviews, averaging 4.8/5 stars:
https://www.amazon.com/gp/product/149...

[Lauren Bates · Rating 3 out of 5]

As a nurse, this book was very interesting. While I don't agree with everything Dr. Lazris addressed, I do think several of the problems with Medicare he brought up, as well of the solutions, are very relevant. It has saddened me to see the economic aspect of healthcare, and often a numbers driven focus can be detrimental to the patient. I recommend this book to anyone who is interested in our healthcare system.

[Marie Hartwell-Walker · Rating 5 out of 5]

Excellent, excellent discussion of Medicare's outdated rules that lead to unnecessary medical interventions as well as unnecessary illness and pain for patients. Those of us on Medicare need to be as educated as possible about how the insurance drives treatment decisions so we can be more successful in advocating what we need.