The industrialization of health care has had some interesting by-products.
In Arizona, when prestigious St. Luke’s hospital was sold to a for-profit chain, the foundation that formerly supported it was free to become an advocate for public education on health care issues. Today I went to the St. Luke’s Health Initiatives conference on the implications of an aging population on healthcare. St. Luke’s has studied this issue for a year, and the report, posted on the web site (http://www.slhi.org), raises more issues than it answers.
Here’s some stuff to depress you:
We never think about this, but in the US, one in 6 of us is sixty, and that proportion is growing every year. By 2025, 20% of the population will be over 65, compared to about 13% today. There will be as many people over 65 as children under 17. That means 40% of the population will not be working, but will require government services.
As a society, we are not organized to have older people in the work force. If we reorganized jobs and provided public transportation, people could be productive longer, and lower the burden on Medicare and Social Security.
But the elderly can’t work forever. By 2030, we will also have doubled the number of people over 85. The number of people in Arizona who will be over 80 in 2030 will equal the population of Mesa, AZ or Cincinnati, OH (365,000).
Everyone knows that fewer and fewer workers will be paying taxes to support the young and the old. More elderly will seek expensive care at the end of life, and Social Security and Medicare will constitute more of an economic burden on workers in the future unless the real economy grows at a rate equal to or greater than the increase in the 65+ population.
If it weren’t for the natural increase in the Hispanic population, we’d have no one to take care of us. As it is, we will probably have to make a choice to fund either health care or education. And the elderly vote, which doesn’t bode well for education.
We have extended our lives, but raised the costs. In our lifetime, corporate-sponsored health insurance will be going away. Health insurance will no longer be provided by corporations in the future, because it is too expensive.
Ironically, when we preach “active aging,” smoking cessation, diet and exercise, we lower costs in the short term, but raise them eventually. A ten-year increase in life expectancy produces a ten-fold increase in health care costs, because as we get older, we get chronic diseases.
The more people we have in the oldest group, the more likely they are to have a whole set of chronic diseases and to take medications for them. And prescription drug costs can push even middle class people into poverty.
The Baby Boomers who are going to face this problem in the next ten years are in denial. That’s because Social Security and Medicare not only support the elderly, but they really support the middle-aged, middle class who would have to take care of the elderly with their own money.
Only 18% of Boomers think that an aging population will be a serious problem for Arizona, although 75% reported some personal anxieties. Boomers are used to getting health care and having someone else pay for it. Almost 80% of the Boomers feel optimistic about growing older.
In 1960, 40% of those 65 and older lived in the home of an adult child. I remember keeping my grandfather and my Uncle Willie until they died. By 1999, this number dropped to 4 %. Boomers will have half the number of children to depend on for support compared to today’s elderly. Put this together with the current and projected shortage of health care workers and the projected Medicare and Social Security shortfalls, and we’ve got a problem.
Technological advances could help solve this problem.
Mapping of the genome will lead us to the age of bioengineering. Cloning will allow for the elimination of Alzheimer’s Disease. Japan already produces drugs that will eliminate most Alzheimer’s and dementia problems. Osteoporosis is also about to be cured. Statins are coming on the market that will be customized for the individual, lowering your cholesterol to just where you want it. Drugs that eliminate plaque are on the near horizon. Drinkable computers can monitor cells that are dying and cloning can replace them.Bi-ventricular synthesizers now can help patients with congestive heart failure. And most of us have access to self-diagnosis instruments such as blood sugar tests and blood pressure monitors. The optimistic scenario is about to occur: technology will save us.
The pessimistic scenario is also about to occur: only some people can afford to be saved. Although the increase in spending in prescription drugs has decreased the spending on hospitals and a dollar of increase in prescriptions leads to a $4 decrease in health care costs, the need and desire for prescription drugs will soon overwhelm even the government.
Why? Because the government pays sticker price to the pharmaceutical companies for those drugs. Pharmaceutical companies have agreed to price controls in every other part of the world except in America. Here, they won’t even let us use purchasing cooperatives to negotiate big discounts (as Canada’s government does).
Big Pharma makes a lot of compaign contributions. So isn’t campaign finance reform as fundamental an issue for good health as anything else?