Where Did My Medicare Go?

Imagine getting older, retiring and finally enjoying the life you worked so hard to build and illness strikes…why is this a problem? We can rely on good, old, dependable Medicare! Unfortunately, the projections for the future of Medicare are terminal with most healthcare economists predicting that Medicare will either be officially declared dead or on substantial life support by 2017.

So how did we get here? Bear with me as I run you through a bit of healthcare policy history. When Lyndon Johnson signed Medicare into law in the mid 1960’s, the average lifespan in the U.S. was 65 years of age. The demographics were also different with few people in the over 65 demographic and the majority of the U. S. population in a younger demographic group paying into Medicare to fund the older group. As diagnostic and treatments for illnesses expanded astronomically over the decades, the average lifespan of Americans increased to approximately age 80. The over 75 age demographic now constitutes the most rapidly growing age group in the U.S. The number of younger adults “paying it forward”  into Medicare is proportionately shrinking due to the decreased birth rate in the U.S.

Healthcare costs in the U.S. hit $2.2 trillion in 2008, accounting for 16.2% of the Gross Domestic Product. The projections for 2015 are that healthcare expenditures will top 20% of the U. S. Gross Domestic Product- unsustainable! Unfortunately, the majority of lifetime healthcare expenditures do not occur on the front end trying to prevent diseases and enhance the quality of life. The majority of a person’s total healthcare expenditures occur in the last months of a person’s life, when high tech, high cost diagnostic and treatment strategies are implemented, with no or limited benefit. Political forces in the U.S. have not allowed these issues to be addressed in any meaningful way. Additional confounders which add up to out of control health care costs are patient expectations, community standards of practice, conflicting clinical guidelines and defensive medicine.

So what can we do as healthcare practitioners and patients to try to “bend the cost curve”? Get educated and educate those around you! Understand what high value, cost conscious care is and live and preach it every day. You can do much to make an impact as a healthcare practitioner, patient and consumer! Stay tuned for more on this in the next segment with “The Four Questions” that every healthcare practitioner and patient should use to approach every healthcare decision….

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Dr. Darilyn Moyer is the Vice Chair and Internal Medicine Program Director, Department of Medicine, and Assistant Dean for Graduate Medical Education, Temple University School of Medicine and Temple University Hospital. She is a Professor of Medicine and Assistant Dean for Graduate Medical Education at Temple University School of Medicine.