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Public Financing of Pain Management: Leaky Umbrellas and Ragged Safety Nets

Published online by Cambridge University Press:  01 January 2021

Timothy S. Jost
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The United States, unlike all other industrialized nations, does not have a comprehensive public system for financing health care. Nevertheless, the magnitude of America's public health care financing effort is remarkable. Of the one trillion dollars the United States spent on health care in 1996, almost half, $483.1 billion, was spent by public programs. In 1995, Medicare—our social insurance program for persons over sixty-five and the long-term disabled—overed 37.5 million Americans; Medicaid—our program for indigent elderly and disabled persons and indigent children and their families—covered 36.3 million. In 1996, Medicare and Medicaid spent $203.1 and $147.7 billion, respectively. The payment policies of these massive public health care programs have a profound effect on the provision of health care.

Many of the recipients of Medicare and Medicaid suffer pain. In 1994, 376,200 Americans over age sixty-five died of cancer. Virtually all of these would have been Medicare recipients, and as many as 70 percent of them died in unrelieved pain. Nearly four million Americans over sixty-five endured the pain of inpatient surgery in 1995, again nearly all of whom were Medicare recipients.

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Article
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Journal of Law, Medicine & Ethics , Volume 26 , Issue 4 , Winter 1998 , pp. 290 - 307
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Copyright © American Society of Law, Medicine and Ethics 1998

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See, authorities cited, supra note 178. In some cases, doctors have subsequently falsified records to support their prescribing. See “Physicians, California,” National Association of Attorneys General, Medicaid Fraud Report (Washington, D.C.: National Association of Attorneys General, May 1994): at 14.Google Scholar
See Fuetsch, M., “Agents Say Mayfield Podiatrist Tried to Trade Drugs for Sex,” Cleveland Plain Dealer, Jan. 26, 1995, at 48.Google Scholar
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Telephone Interview with Ben Bailey, Attorney, Bowles, Rice, McDavid, Graff, and Love (Mar. 17, 1998).Google Scholar
See Office of Inspector General, “Special Fraud Alert: Fraud and Abuse in Nursing Homes Arrangements with Hospices,” 63 Fed. Reg. 20,415 (1998). The most recent OIG report on hospices, however, reveals that formal plans of care were found for 96 percent of hospice beneficiaries, and that, in 99 percent of the hospice records reviewed, documentation confirmed that the beneficiaries and their families were receiving care as indicated by the plans of care. See Hospice Beneficiaries, supra note 78, at 4.Google Scholar
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See, for example, Sparrow, M.K., License to Steal: Why Fraud Plagues America's Health Care System (Boulder: Westview Press, 1996) (describing the seriousness of the health care fraud problem).Google Scholar
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