The Medicare Problem
What does Alan Greenspan believe poses the greatest threat to the US economy?
A) The war in Iraq
B) The mortgage/housing crisis
C) The trade deficit
D) Gasoline prices
None of the above. The answer is Medicare.
Fortune Magazine's Geoff Colvin:
"Unfortunately the day of reckoning is imminent. Sometime in the next President's first term, Medicare Part A (hospital insurance) will go cash-flow-negative, and it's all downhill from there. (...) The federal budget has averaged about 18% of GDP over the past several decades. If that average holds and if the rules of our social insurance programs don't change, then by 2070, when today's kids are retiring, Medicare, Medicaid, and Social Security will consume the entire federal budget, with Medicare taking by far the largest share. No Army, no Navy, no Education Department - just those three programs."
The problem is actually much worse than that, because the above projection relies upon unworkable assumptions. So how can we bail out this failing social program? We're going to have to change the rules.
I'd start by raising the Medicare eligibility age to 70, but eventually it will need to go even higher. When the Medicare program was first signed into law in 1965, the average US life expectancy at birth was 70 years. Despite the fact that medical advances have increased our current life expectancy to over 77 years, the Medicare eligibility age has remained constant. Even indexing Medicare eligibility to life expectancy might not be enough to save the program, however.
So what other changes can we make?
The Happy Hospitalist has some brilliant suggestions, but some of you are going to be shocked and horrified by them. The truth hurts sometimes. Go there now and read his take.
A) The war in Iraq
B) The mortgage/housing crisis
C) The trade deficit
D) Gasoline prices
None of the above. The answer is Medicare.
Fortune Magazine's Geoff Colvin:
"Unfortunately the day of reckoning is imminent. Sometime in the next President's first term, Medicare Part A (hospital insurance) will go cash-flow-negative, and it's all downhill from there. (...) The federal budget has averaged about 18% of GDP over the past several decades. If that average holds and if the rules of our social insurance programs don't change, then by 2070, when today's kids are retiring, Medicare, Medicaid, and Social Security will consume the entire federal budget, with Medicare taking by far the largest share. No Army, no Navy, no Education Department - just those three programs."
The problem is actually much worse than that, because the above projection relies upon unworkable assumptions. So how can we bail out this failing social program? We're going to have to change the rules.
I'd start by raising the Medicare eligibility age to 70, but eventually it will need to go even higher. When the Medicare program was first signed into law in 1965, the average US life expectancy at birth was 70 years. Despite the fact that medical advances have increased our current life expectancy to over 77 years, the Medicare eligibility age has remained constant. Even indexing Medicare eligibility to life expectancy might not be enough to save the program, however.
So what other changes can we make?
The Happy Hospitalist has some brilliant suggestions, but some of you are going to be shocked and horrified by them. The truth hurts sometimes. Go there now and read his take.
Labels: health care crisis, links to greatness
posted by scalpel at 5:15 PM
4 Comments:
The two-tiered system is coming.
Goes back to the "Fast care, free care, quality care - Pick Any Two" dilemma. No one will choose low quality care. We will therefore be left with two tiers:
1. Those who can afford to pay for care and who will receive it quickly and
2. Those who cannot afford the care and have it slowly rationed as in other countries.
The only problem is that the changes have to come quickly, so we can't be treated as the usual "frog in the boiling pot of water" routine.
Honestly Scalpel, I think that his suggestions were very reasonable. I would have no problem living by those rules. I really think that a lot of measures we take to extend life are cruel.
When my Granddad broke his hip at 91, he decided he was done living. We respected his decision although we loved him dearly, and would miss him so much, we all knew he wasn't happy in a nursing home. He quit taking his meds and he quit eating, but he was surrounded by family and that was the most important part.
Yesterday I operated on a lady who broke her hip on her 93rd birthday. She had severe osteoarthritis in that hip, so just repairing the fracture wasn't a good option. She had a very expensive total hip arthroplasty. Was it justifiable to do that? Should I have just given her narcotics and let her dwindle away? Or maybe not even that? I hope I never have to make the really tough decisions. It is fine for the patient to say "I've had a good, long life. Just let me go to sleep now." I'm okay with that. I am not okay with a politician saying that.
I think that surgery would be justified. Elective knee replacement, not so much.
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