Medicare
As I've mentioned before, Ronni Bennett's blog Time Goes By is one of my favorites. Anyone over the age of 50 should visit regularly, as should those who have parents over the age of 50 or who know someone over the age of 50. Her take on aging and on elder issues is always on the mark, primarily because Ms. Bennett takes a wide-ranging interest in all of the issues facing all Americans. She just adds the perspective of experience.
Her post today is a pretty good example of what I mean. It's an interview with Robert N. Butler, M.D, one of the earliest and most indefatigable experts on aging and longevity in the nation. Dr. Butler has just published a new book, The Longevity Revolution – The Benefits and Challenges of Living a Long Life, which explores the effects of more people living longer.
The part of the interview which particularly interested me had to do with what effect increasing longevity is going to have on Medicare, especially in light of the latest report from the Medicare Trustees.
RB: You state unequivocally that an aging population does NOT account for rising health costs and that excessive medical costs are NOT associated with the end of life. A lot of people don’t believe that…
RNB: It is technology, drugs, so far, that account for the rising health costs not the aging of the population. This could change, of course, with increasing aging. End-of-life care can be expensive whenever end of life occurs. For example, a young person in an automobile accident, a young woman with breast cancer, but in old age per se, the per capita expenditure at the end of life actually declines and the proportion of Medicare that goes to end-of-life care has remained stable for more than the last 20 years.
RB: The federal government has just released some scary statistics on Medicare – that at its current level of payout, spending will exceed revenue by 2019. Do you have a solution?
RNB: The solution to the issue of Medicare is to change the reimbursement system which favors the procedural and technological specialties rather than primary care. It does not adequately support prevention.
The solution to Medicare ultimately has to be reforms in the healthcare system in general. We need new systems of healthcare delivery, more primary care, more prevention, more investments in research and a better trained healthcare workforce to take care of old people. {Emphasis added]
Dr. Butler is not by any means suggesting that Medicare is a failure. In fact, he suggests in the interview that it could serve as a model for national program of universal access to health care. Administrative costs in Medicare are only 2%. Private insurance companies do well to keep those costs at 20%. What he does suggest is that before Medicare can be more effective at what it does, it needs to be part of an overall change in how we view health care and how we establish priorities within that system.
The looming shortfall in the Medicare system, however, can't wait for a new generation of well-trained professionals in the primary care field. We do need some quick fixes, and soon. A recent NY Times editorial suggests a start in the right direction:
This year’s report again warned that Medicare will soon be violating an absurd Congressional mandate that it can use general tax revenues — mostly generated by the progressive income tax — to pay only 45 percent of the program’s total expenditures, and must rely on the payroll tax and payments by beneficiaries to cover the rest. We have criticized that foolishness before and can only hope that the next Congress eliminates the cap so that Medicare’s financial troubles can be approached more sensibly.
Getting Medicare on a sounder financial footing now would make possible the kind of health care overhaul that is so drastically needed more feasible. And the elimination of that cap should be high on the congressional agenda.
Her post today is a pretty good example of what I mean. It's an interview with Robert N. Butler, M.D, one of the earliest and most indefatigable experts on aging and longevity in the nation. Dr. Butler has just published a new book, The Longevity Revolution – The Benefits and Challenges of Living a Long Life, which explores the effects of more people living longer.
The part of the interview which particularly interested me had to do with what effect increasing longevity is going to have on Medicare, especially in light of the latest report from the Medicare Trustees.
RB: You state unequivocally that an aging population does NOT account for rising health costs and that excessive medical costs are NOT associated with the end of life. A lot of people don’t believe that…
RNB: It is technology, drugs, so far, that account for the rising health costs not the aging of the population. This could change, of course, with increasing aging. End-of-life care can be expensive whenever end of life occurs. For example, a young person in an automobile accident, a young woman with breast cancer, but in old age per se, the per capita expenditure at the end of life actually declines and the proportion of Medicare that goes to end-of-life care has remained stable for more than the last 20 years.
RB: The federal government has just released some scary statistics on Medicare – that at its current level of payout, spending will exceed revenue by 2019. Do you have a solution?
RNB: The solution to the issue of Medicare is to change the reimbursement system which favors the procedural and technological specialties rather than primary care. It does not adequately support prevention.
The solution to Medicare ultimately has to be reforms in the healthcare system in general. We need new systems of healthcare delivery, more primary care, more prevention, more investments in research and a better trained healthcare workforce to take care of old people. {Emphasis added]
Dr. Butler is not by any means suggesting that Medicare is a failure. In fact, he suggests in the interview that it could serve as a model for national program of universal access to health care. Administrative costs in Medicare are only 2%. Private insurance companies do well to keep those costs at 20%. What he does suggest is that before Medicare can be more effective at what it does, it needs to be part of an overall change in how we view health care and how we establish priorities within that system.
The looming shortfall in the Medicare system, however, can't wait for a new generation of well-trained professionals in the primary care field. We do need some quick fixes, and soon. A recent NY Times editorial suggests a start in the right direction:
This year’s report again warned that Medicare will soon be violating an absurd Congressional mandate that it can use general tax revenues — mostly generated by the progressive income tax — to pay only 45 percent of the program’s total expenditures, and must rely on the payroll tax and payments by beneficiaries to cover the rest. We have criticized that foolishness before and can only hope that the next Congress eliminates the cap so that Medicare’s financial troubles can be approached more sensibly.
Getting Medicare on a sounder financial footing now would make possible the kind of health care overhaul that is so drastically needed more feasible. And the elimination of that cap should be high on the congressional agenda.
Labels: Elders, Health Care, Medicare, Universal Health Care Access
posted by Diane at 1:53 PM
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