A provocative essay in the New York Times details how Medicare may benefit providers, but not always help the patients it is meant to protect.

Former Times reporter Jane Gross says that Medicare's "central flaw" is that the program pays for unnecessary care while failing to cover “what is actually useful” to the elderly, like extended care. For example, Gross lists several procedures that are rarely beneficial and possibly harmful—but which are covered by Medicare.

• Feeding tubes for patients with dementia, which rarely prolong life and lead to infections and potential agitation;
• Abdominal and gallbladder surgery for frail patients; and
• Tight glycemic control for elderly patients with Type 2 diabetes.

Gross also highlighted her own mother's experience, who spent more than $500,000 on out-of-pocket care—including time at a nursing home, electric wheelchairs, and health aides—that Gross believes was necessary and vital.

However, Medicare covered expensive procedures and diagnostic tests for Gross' mother, like a neurosurgery operation that was not expected to be effective.

The Medicare 'mismatch'
Gross notes that Medicare rarely covers long-term or extended care services, which roughly 70% of elderly patients will require before they die. The median annual cost of a nursing home in 2010 was $75,000, while the median cost of an assisted living facility was $37,500—and the elderly must pay these costs "out of pocket until their pockets are all but empty."

Meanwhile, Gross argues that Medicare is spending far too much on "heroic" care—such as diagnostic tests, costly surgeries, expensive prescription drugs, and ED and hospital visits—that do not benefit elderly patients near the end of life.

No political solution in sight
The issue will steadily mount, Gross argues, because of rising Medicare expenditures. According to health economist Marilyn Moon, there are 47 million Medicare beneficiaries, who account for roughly half a trillion dollars—or nearly one-fifth—of annual U.S. health care outlays. The number of beneficiaries is expected to balloon to 89 million by 2050.

However, Gross notes that several attempts to bolster long-term care coverage have come under siege—most notably President Obama's effort to reimburse physicians who discussed end-of-life issues with patients, which was ultimately dubbed as a "death panel." According to Gross, while the current system is unsustainable, no one is asking the tough questions because Medicare "is the third rail of health care policy" (Gross, Times, 10/15).