Milissa Holland Live is on the air today, Friday, between 10 and 11 a.m. on WNZF 1550 AM, discussing the topic below. To ask questions or dial into the show, reach Holland by email here, on Facebook or on Twitter. While she’s on the air, call her at 386/206-WNZF (or 206-9693).
By Milissa Holland
Warren Buffet made one of the best proposals about the deficit in a 2011 interview on CNBC. “I could end the deficit in five minutes,” he said. “You just pass a law that says that anytime there is a deficit of more than 3 percent of GDP, all sitting members of Congress are ineligible for re-election.” The likelihood of them passing such a law is slim to none but I like the concept: accountability.
I get it. The deficit is a complex issue and it took us years to get here. But not tackling it after all these years is truly the definition of insanity, particularly when it comes to Medicare and Medicaid, the health insurance programs for the poor and elderly.
My grandfather passed away about a year ago. He grew up in the depression, served in the military, worked hard his entire life to provide for his family, and paid his taxes faithfully. He was married to my grandmother for 64 years and spent the last four years of her life taking care of her as she battled leukemia. He ended up spending the remaining years of his life in more doctors’ offices than I could count. They were both on Medicare supplemented with my grandfather’s insurance plan. I sit here wondering what he would have done without Medicare.
Yet Medicare and Medicaid spending would — if unaddressed — continue to grow at rates higher than 3 percent a year over the next 75 years. But don’t blame it all on the baby boomers. How physicians and hospitals are paid and how technology and new treatments drive costs has a lot to do with it. What can our parents or grandparents expect in the coming years when these systems are bankrupt? Why are health care costs growing so fast? As technology improves shouldn’t we see a decrease in overall costs to the system?
It’s an interesting fact that 90 percent of your health spending takes place in the last year of life. As you get older, keeping you alive is a cocktail of complexity. Organs fail. You need more specialists, more drugs, more diagnoses, just to keep you alive or to try to maintain some quality of life. An elderly patient can take up to 10 to 20 times the resources of a middle-aged adult.
And so much of the population is getting older. That’s a good thing. It’s also a very costly thing. Older people means more cancers, more Alzheimer’s cases (13.8 million forecast by 2050), more bypass surgeries, more diabetes. None of that is cheap. Technology allows us to treat more diseases, and to treat them better, but not necessarily less expensively.
Many health system reform proposals call for electronic medical records, which will help reduce costs, but mostly because the data they will generate will show which treatments are more effective. That recommended proposal is coming together slowly because very few doctors and hospitals have electronic records systems.
Samir Mehta, Ryan Nunley and others, writing on issues facing Medicaid, put it clearly: “Perhaps no governmental healthcare programs have helped as many people as Medicare and Medicaid. The Medicaid program is the third-largest source of health insurance in the United States—after employer-based coverage and Medicare. But, just as the Medicare program is facing overload with millions of baby boomers beginning to qualify, the Medicaid program—a joint venture between federal and state governments—is also under stress.”
They go on: “When seniors are eligible for dual enrollment for both, it compounds the problem. Indeed, many of the problems faced by patients and physicians in the Medicare program are exacerbated in the Medicaid population. Although the elderly and the disabled account for 25 percent of individuals enrolled in Medicaid, they are responsible for 69 percent of Medicaid spending. In contrast, children account for nearly half of those covered by Medicaid, but only benefit from 19 percent of Medicaid dollars. Economists and health policy experts agree that Medicaid and Medicare are unsustainable in their current forms, because they are growing much faster than the economy or the revenues used to finance them. With no change in existing law, the Congressional Budget Office says that the cost of Medicaid will double in 10 years and the program will account for more than 20 percent of the budget.”
So what can we do to address the issue?
Last week I addressed the issues of health and wellness, which are directly correlated to this discussion. We all take personal responsibility for the choices we make in our life, or should. When we purchase car insurance, our driving history has a direct impact on the premium cost we’re quoted. After a few years of good driving behavior we see a reduction in our cost for the service – hence saving money in our household budget.
For the users of this health care system, I just don’t see where there is an incentive to make better choices. I know through my experience on the Flagler County Commission that a lot of the users of Medicaid use our emergency rooms as if they were going to see a primary care physician. All that does is drive up the costs substantially. We know that the state’s Medicaid billing system is flawed because the state was kind enough to hand down a $450,000 bill for our residents to pay last year, after admitting to an error. No lack of responsibility there?
Considering what we know is broken, I hear very little discussion about creating a managed care system—one that educates and informs the users about choices. How many times as a parent have you made the decision to go to the pharmacy when your child is sick rather than visit the ER? I know I have because of the cost associated with that decision. If we focused our efforts on dealing with child obesity for instance (a good first step would be restoring gym class in schools) then the net effect long term would be a healthier population. One that doesn’t require thousands of tests and unlimited supply of prescription medication. It would be a more sustainable system overall.
Managed care along those lines isn’t going to solve all the issues, but it’s a good start. This week’s show on Milissa Holland Live will be a discussion on this very issue. I will be bringing the physicians and the policy makers and private insurers together for this very important topic.
I look forward to your input and questions. Tune in Friday.
Milissa Holland, a Flagler County commissioner from 2006 to 2012, is host of Milissa Holland Live on WNZF 1550 AM, Fridays at 10 a.m. Her column will appear here every Wednesday. Reach her by email here, on Facebook or on Twitter. While she’s on the air Friday morning between 10 and 11, call her at 386/206-WNZF (or 206-9693).