TY - JOUR T1 - Another message from America: nutz! JF - British Journal of General Practice JO - Br J Gen Pract SP - 635 LP - 636 DO - 10.3399/bjgp11X601451 VL - 61 IS - 591 AU - John Frey Y1 - 2011/10/01 UR - http://bjgp.org/content/61/591/635.abstract N2 - The comedian Bill Cosby had a particularly funny routine about how, as a child, he would listen to scary stories on the radio and become convinced that terrible things would happen to him. One radio programme featured a giant beating chicken heart that threatens to eat New York, about which Cosby had nightmares. If not reformed, Medicare, the federal government sponsored healthcare programme for Americans over 65 and people with disabilities, really will eat the US economy. The atmosphere of brinksmanship and demagoguery that has characterised US politics since Obama was elected has made discussion of Medicare reform politically unfeasible. A progressive tax on wealthy Medicare recipients? ‘No new taxes!’ Restricting choices of unproven medications or procedures? ‘Rationing!’ Arranging a system where patients must see their GP before getting specialty care for their upset stomach? ‘Restricting my freedom!’. So it goes on. Medicare is driving the US economy toward the precipice and was the chief source of the recent endgame negotiations on the debt ceiling. It seems more likely that the US Government would close its military bases in the rest of the world than reform Medicare. Older people vote at a much higher level than any other group. They see Medicare as a promise that they have funded with increasing personal taxes for their working lifetimes. One disclaimer is that I, too, have been a Medicare beneficiary for 2 years.Medicare has three parts — one for hospitals, one for doctors, and one for drugs. The first two have been there from the beginning. The part that pays hospitals is required, which should give some insight into which component of the US health system has the biggest dog in this hunt. Hospitals are addicted to Medicare and negotiated that dependency from its beginning 45 years ago. The second part … ER -