Tuesday, August 22, 2006

If you want to get serious about fixing Medicare...

Front paged at Booman Tribune and ePluribus Media

Despite the fact that Bush has been trying to hoodwink We the People into thinking that Social Security is in dire straits and must be destroyed in order to "fix it", there is a much bigger problem - Medicare. And I don't just mean the Medicare Part D mess that was a boon to the drug companies at the expense of many of our senior citizens.

A new study released yesterday on the journal Health Affairs' website has some startling conclusions. For starters, overall spending on Medicare is anticipated to jump from its current level of 3% of GDP in 2006 to a whopping 8.8% of GDP in just over 20 years. But the real issue here is the underlying reasons why Medicare spending is projected to increase by nearly threefold.

And the reasons, while painting a pretty depressing but accurate picture of `Murka, leads to a basic answer as to what can be done to (somewhat) manage the huge projected spending increase, as well as the huge current spending on Medicare - the way Americans treat (or more accurately, mistreat) their bodies.

The underlying reason for much of the spending? A vast increase in obesity in America over the past 25 years. The results of this? Well, health issues, of course - increased risk of heart disease, diabetes, high blood pressure and other similar ailments. According to a brief synopsis in USA Today, the numbers are staggering:

The rate of obesity among Medicare patients doubled from 1987 to 2002, and spending on those individuals more than doubled, according to economists Kenneth Thorpe and David Howard.


In 1987, 11.7% of the Medicare population was considered obese. That number grew to 22.5% of Medicare enrollees by 2002.

Spending on medical care for obese Medicare patients was 9.4% of the federal government program's budget in 1987 but jumped to 24.8% by 2002, according to the analysis.

These numbers don't even consider what will happen over the next 5 years when the baby boomers start to retire in greater numbers and will rely on Medicare after the explosion of the sugar cereal/preservatives/bleached flour/chemical laden snacks and soda industry of the past 35 or so years, coupled with a decline in physical activities (thank you video games...). And with that will no doubt come a greater number of people who are obese or who have major health problems.

In fact, according to the study and as you can see from the following chart, over the 15 year period from 1987 through 2002, over 16% of the total increase in Medicare spending was on the "top 10" conditions, which include heart disease, diabetes, cancer and hypertension.

This is not the only disturbing trend. As far as how many conditions treated per individual goes, there is a sharp increase in the number of individuals who have had multiple conditions:

he number of medical conditions treated per Medicare beneficiary has risen sharply over time. In 1987, 31 percent of Medicare beneficiaries received treatment for five or more conditions. This group accounted for about half of total spending. Ten years later, nearly 40 percent of beneficiaries were treated for five or more conditions, accounting for 65 percent of overall spending. And just five years later, more than half of all Medicare beneficiaries were treated for five or more conditions, accounting for three-fourths of total spending. Virtually all of the spending growth since 1987 can be traced to patients treated for five or more conditions. And in 2002, 92.9 percent of health care spending was incurred by beneficiaries with three or more conditions during the year.

Now there are a number of factors at play here, but the most obvious one noted in the study is that of obesity. As you can see from the following chart, the level of obesity in Medicare beneficiaries has doubled since 1987. However, the amount of Medicare spending on these beneficiaries has nearly tripled. Compare that to the slighter increase in overall Medicare spending on that part of the population who is NOT obese.

Overall, the prevalence of obesity among Medicare beneficiaries has doubled since 1987, but the share of spending incurred by obese beneficiaries has almost tripled--from 9.4 percent to nearly 25 percent of total spending. Thus, a rise in the share of obese Medicare beneficiaries combined with a higher share treated for five or more conditions over time accounts for about fifteen percentage points of the rise in spending.

The share of normal-weight beneficiaries (as defined by body mass index, or BMI) treated for five or more conditions increased from 11.5 percent of all beneficiaries in 1987 to 16 percent in 2002, even as the overall share of the normal-weight group declined. The overall share of spending associated with this group (normal weight treated for five or more conditions) increased from 19.6 percent in 1987 to 24.1 percent in 2002. Treatment for hyperlipidemia, mental disorders, and osteoporosis and other bone disorders accounted for the largest increment in treated prevalence among normal-weight beneficiaries treated for five or more conditions (tabulations not shown). Similar trends were observed among overweight beneficiaries.

So, to bring this all back together with a pretty bow on top, what is the answer? Well, clearly there is a problem here in America with rising obesity. Somebody did an excellent diary on this a few weeks back, but sadly I can't seem to find the link.

The answer is a major lifestyle change on the part of America - and as we all know, this is no small feat. Children are being bombarded with TV ads for the latest sugary snacks with catchy jingles and cool cartoon shapes or packaging. A lessening of the focus on physical activities for children (not to mention after school sports programs or community youth activities being cut all across the country) create a more sedentary life for children. The rise of totally cool looking video games make it easier for someone to pretend he is LeBron James or Peyton Manning instead of picking up a basketball or football and throwing it around.

Many parents are either working multiple jobs, or are not taking as much of an interest in raising their children (just my observation). Fast food and 5 minute dinners which are laden with chemicals and other crap have become so easy and inexpensive. The federal government, whether it be the USDA or lobbyist groups have more of a vested interest in lining their pockets or avoiding the "hard decisions" in order to promote a healthier lifestyle for children as well as teens. Many people in lower income neighborhoods don't have the means or the access to healthier options, when it comes to food.

But all of these things are really just excuses now, and will result in MAJOR health problems later - not to mention the increased strain on Medicare costs. The data is there. The choices are simple to make, yet complex to implement unless there is a major push on all fronts.

I remember when I was a kid in grade school, how much of a focus there was on physical education. There were programs in the school systems. There was the "Presidential Fitness Awards" (or something like that). Unless there is a major shift (which may not even involve too much other than a shifting of priorities all around as well as some strength of conviction), things will continue to get worse. Obesity will continue to spiral out of control. Medicare costs will continue to skyrocket. The overall health of Americans will continue to decline, despite having the most amount of spending on healthcare overall.

But it doesn't have to be that way. It just takes courage and some common sense all around. Even small changes can go a long way and make a big difference in lifestyles, health, and Medicare costs.

No comments: