With many Republicans forecasting the end of Medicare for those under 55 and few members of my own Democratic Party willing to propose sweeping reforms to preserve it, several Washington insiders speculate that serious Medicare reform will remain a third rail of American politics.
Yet based on my experience, common ground on Medicare is possible and, in the short term, policymakers have an immediate and time-sensitive opportunity to prevent and manage costly chronic illnesses such as cancer, diabetes and hypertension through a coordinated approach to treating patients led by home health care. By strengthening options that let people get much-needed care at home, policymakers can save money, give older Americans what they want and address the chronic disease epidemic facing our nation.
Consider the following: Nearly three quarters of those who live to 85 will eventually need health assistance ranging from simple help around the house to 24-hour skilled nursing care. According to the Department of Health and Human Services, a week in a private nursing home room costs about $1,500 while a week of home health care costs considerably less.
If Congress accelerates already planned cuts in home health care (currently under consideration) or raises fees on seniors even more, it will encourage many to enter costly nursing homes and, eventually, increasing the overall cost of the Medicare program. This defies fiscal and political logic.
Moreover, policies that force seniors into nursing homes through cuts to home health spending will directly impact our efforts to prevent and manage chronic disease. The cuts reduce the capacity to provide health care services to chronically ill patients at home. Patients with chronic disease account for 75 percent of U.S. health spending and the numbers are higher in entitlement programs. Eighty-three percent of every dollar in Medicaid is spent on chronic disease and 99 percent in Medicare.
The best chance America has to alleviate this burden is by creating a coordinated team-based approach to health care in which doctors, nurses, nurse practitioners, home health aides and patients are all working together to treat and get in front of chronic conditions. While some individuals have needs that require care only institutional settings can provide, few should leave friends, family, and familiar places simply because they need extra help.
Home health aides spend much more "face time" with seniors and disabled persons than doctors and nurses. Our medical system must take advantage of this. With better information technology -- interoperable electronic medical records in particular -- and improved integration between health providers of all sorts, home health workers can serve as a "front door" to a better-coordinated medical system. Improved coordination of care, in turn, can save money (it's almost always cheaper to treat problems early), reduce medical errors, and improve quality of life for Americans on Medicare.
Such home and community-based solutions should appeal to both ends of the political spectrum. Republicans intent on cutting the budget should know that they'll save money by reducing the need for institutional care. Democrats who want to raise the quality of public services should be secure in the knowledge that home health care spending will do just that. Providing opportunities for patients to receive their health care services at home rather than at more expensive institutional settings is a common sense solution.
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