The Elder Law Forum By Professor Michael Myers "A Deal They Can't Refuse?" A 69-year-old man who called the USD Senior Legal Helpline believed he had an offer the federal government — specifically "Medicare" — could not refuse. Eighteen months ago he was diagnosed with coronary artery disease. He underwent an angioplasty procedure and the implantation of a stent, a small metal device used to hold open heart arteries. "The procedure was non-eventful, but my recovery from surgery was slow and miserable. I'm not interested in going through it again," he said. But, according to his physicians, he should. Sometime during the past year the stent dislodged from its implanted site. As a result, the artery has ballooned, thinning the wall and threatening a pulmonary artery rupture, a devastating complication associated with a pulmonary artery catheter. "They told me a rupture is almost certain to occur and that I will be dead before I hit the ground," he said. The proposed surgical repair will be expensive. Medicare paid $94,000 for the original surgery – $50,000 to the hospital; $40,000 to the doctor, and $4,000 for miscellaneous therapy. His physician estimates the second surgery will cost $100,000. "I reflected upon the cost of all of this and the risk of not accepting my doctor's recommendation and I think I have come up with a way that both I and the taxpayers could come out ahead," said the caller. "Now here is my deal: I will sign a contract with Medicare promising that I will not have the problem fixed and will never seek a dime from the federal government for any further treatment for my heart. That will save Medicare $100,000. All I ask it that they split it with me fifty-fifty. Medicare saves $50,000. I get $50,000. Both of us would be better off. "What do you think professor? Will they go for it?" he asked. "No," I advised. American medicine is rooted in marketplace capitalism and the profit motive. Doctors and hospitals are rewarded for doing more; more surgery, more drugs, more CT-Scans, more physical therapy, more of everything. It is unlike European medicine where doctors are paid fixed salaries and lack the financial conflict of interest inherent in volume-based medicine. Neither American nor European healthcare systems contain financial rewards for avoiding doctors and hospitals. Perhaps they should. (Pro bono legal information and advice is available to persons 55 and older through the USD Senior Legal Helpline at 1-800747-1895; email@example.com. Opinions solely those of the author and not the University of South Dakota).