The Medicare Wellness Farce

Jane M. Orient, M.D.,

The real news about Medicare should be the Gang of 15, namely the IPAB or Independent Payment Advisory Board. It is charged with putting a lid on Medicare spending, with no judicial or congressional oversight.

The only tool it is allowed to use is to not pay for services, or to pay far below cost. Guess what happens when you stop paying people, even doctors? They stop working, and thus stop ordering expensive medicines and tests.

But the government prefers to emphasize the AWV or annual wellness visit. You get a “free” visit to the doctor, or rather “health care provider,” and that’s somehow supposed to keep you well. At least it will keep sick people out of the doctor’s office, which will be jammed with people having AWVs, for which the doctor gets paid better.

Medicare payment for the first AWV is $161.05, and for a follow-up is $107.37, and there’s no deductible or copay.

Most of the “no touch” visit can be done by a nurse and other team members, such as a health educator. It involves determining your height, weight, and waistline circumference or body mass index (BMI). If you are overweight, you will be scolded and given evidence-based advice to lose weight.

You will probably be given a government-approved low-fat diet, which has been shown not to work, and when it doesn’t, you will be called “non-adherent” (the new preferred term for “non-compliant”). You will be interrogated about smoking, told that it is bad for you, and counseled if you admit to doing it.

You’ll likely be referred to an evidence-based smoking cessation program (which ObamaCare pays for with your tax dollars even if it doesn’t work) and probably given an alternate nicotine-delivery system, which will likely maintain your nicotine addiction so that you will keep paying tobacco taxes.

You’ll be screened for risk factors for depression and for mental health or cognitive problems. You’ll be checked for risk of falling down.

A list will be created of your medications and all your regular providers and suppliers.

If the government gets its way, all this information will be entered into an electronic database. This will make it convenient to determine the societal value of your medical treatment, just in case the IPAB Gang decides that resources need to be redistributed to those who are not obese or showing early signs of dementia.

If you have any health problems, they won’t be treated during this visit—it’s a “wellness” visit, remember?

The AWV won’t be mandatory, at least not yet, but your doctor might well insist on it—after all, he does get paid relatively well for it.

Would you spend your own money on this? For $160, I could make my own lists and calculate my own BMI. You just need to find an internet site by “Googling” and plug in your height and weight. Perhaps I’d like to keep the results to myself!

Taxpayers of course have no choice about buying wellness visits (AWVs) for other people. But it’s supposed to be worth it by saving them money in the long run.

Measuring your waistline will not protect you from heart disease, cancer, Alzheimer’s, or even from falling down. And age 65 is a little late to start your healthy living program. But this is about maximizing the health of the herd —er, I mean population. The culled information will help the IPAB Gang of 15 get the best bang for other people’s bucks.

Even in the short term, there will be savings—simply by keeping those troublesome sick people from clogging up medical facilities, with their demands for frequent return visits, prescriptions, medical equipment, and diagnostic tests.

It is much better for society to keep healthy people healthy than to lavish resources on keeping sick people alive. Isn’t it?


Dr. Jane OrientDr. Jane M. Orient, M.D., has appeared on major television and radio networks in the U.S. speaking about issues related to Healthcare Reform.

Dr. Jane Orient is the executive director of the Association of American Physicians and Surgeons, a voice for patients’ and physicians’ independence since 1943.

She is currently president of Doctors for Disaster Preparedness and has been the chairman of the Public Health Committee of the Pima County (Arizona) Medical Society since 1988.

Dr. Jane Orient has been in solo practice of general internal medicine in Tucson since 1981 and is a clinical lecturer in medicine at the University of Arizona College of Medicine. Her op-eds have been published in hundreds of local and national newspapers, magazines, internet, followed on major blogs and covered in the Wall Street Journal and the New York Times.

Dr. Jane Orient authored YOUR Doctor Is Not In: Healthy Skepticism about National Health Care, published by Crown; the second through fourth editions of Sapira’s Art and Science of Bedside Diagnosis, published by Lippincott, Williams & Wilkins; and Sutton’s Law, a novel about where the money is in medicine today.

She is the editor of AAPS News, the Doctors for Disaster Preparedness Newsletter, and Civil Defense Perspectives, and is the managing editor of the Journal of American Physicians and Surgeons.

Dr. Orient’s position on healthcare reform:

“The Healthcare plan will increase individual health insurance costs, and if the federal government puts price controls on the premiums, the companies will simply have to go out of business. Promises are made, but the Plan will deliver higher costs, more hassles, fewer choices, less innovation, and less patient care.”

More info about Dr. Jane Orient


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