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Tuesday, August 21, 2012

With Medicare we have seen the enemy and it is "us"

      With the selection of Paul Ryan to the Republican ticket a much needed discussion has occurred about the precarious viability of the Medicare program.  Unfortunately this discussion is occurring within a partisan political debate that generates much much heat but little in depth rational analysis.  Much of the debate seems to be trying to win the votes of the senior citizen population and portray the other as "pushing granny over the cliff."

     As with much in life when we look at a problem we that have to own up to the fact that we have prolonged illnesses in the final year of life and especially the final two months of life have always accounted for a significant portion of the Medicare (and Medicaid) budget.  The numbers are 28% of costs in the final year of life and 12% in the final two months of life.

 Chronic conditions such as arthritis, heart disease, kidney disease, respiratory  and especially diabetes has driven up costs of medical care for the elderly.  Four of the five conditions above have a significant relationship to the lifestyle choices we make.  Throw in the lifestyle choices related to many cancers and you can see that we are paying an enormous costs for many of our poor lifestyle costs.
  
    In an article in the magazine of the American Diabetes Association the problem is outlined this way:

   "The diabetes population and the related costs are expected to at least double in the next 25 years. Without significant changes in public or private strategies, this population and cost growth are expected to add a significant strain to an overburdened health care system."

     "The high cost of caring for individuals with chronic diseases is one of the most pressing issues in health care in the U.S. today. The baby boom generation is aging, and advanced age is accompanied by costly chronic illnesses. As a result, Medicare and other health-related governmental programs will face demographic and epidemiological forces that will challenge their financial viability." 

   Finally when you are talking about chronic illnesses the fragmentation of our health care system becomes a major spending and health care issue.  The Healthcare Financial Management Association explains it this way:
     "System fragmentation means that chronically ill patients receive episodic care from multiple providers who rarely coordinate the care they deliver, and chronic disease management programs are notably absent in traditional fee-for-service Medicare. As Congress, the administration, providers, insurers, and consumers debate reshaping the U.S. health system, they must address these changed health needs through evidence-based preventive care.”
    
    So is there a solution to the solvency of Medicare?  Like every other budget issue it comes down to slowing costs, cutting benefits or raising revenue (i.e. taxes).  With our present uncoordinated care system of health care controlling the cost increase will be next to impossible without some type of rationing which is politically difficult.  That leaves the option of benefit reduction by most likely raising the age of eligibility (to 66 or 67) and raising the Medicare tax.  Unfortunately we all know how likely that compromise is with the current Congress.

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