As the new Congress threatens to repeal health care reform and Republicans and deficit reduction panels eye major entitlement cuts, Medicare has become their central battleground, just as the first of 78 million Boomers turn 65 and begin joining the program.
The deficit hawks have a point. Even Medicare's most ardent defenders admit that, without changes in organization and financing, government health care expenditures will double in the next seven years. If Medicare is to survive, we must "bend the cost curve," particularly for its greatest consumers: high-need, high-cost older patients.
The question is, how? As a health services researcher and professor of medicine, and recalling the classic movie The Graduate, my advice to America's policymakers, to present and future Medicare beneficiaries, as well as present and future physicians is one word: geriatrics.
Caring for our fast-aging population has become the central health care challenge of our time, making geriatrics a discipline whose time has come. A sub-specialty of internal medicine, geriatrics encompasses the scientific study of aging, the teaching of excellent care, and the provision of that excellent hands-on clinical care to older people, especially the most vulnerable. Now is the time to pay greater attention to all three agendas, and to recognize that repeal would undermine all three.
The first challenge -- delivering the care seniors need -- demands a strategic re-balancing of our health care workforce. We desperately need more primary care physicians, including geriatricians (there are only about 7,000 in America today), as well as biomedical researchers and academics with expertise in geriatrics who can conduct research, develop and implement better models of care delivery, and train the next generation of doctors.
Recruiting them will require inspiring medical students and even mid-career doctors to give geriatrics a second look. The bad news is that geriatrics is a relatively young field that is not always promoted during medical education as energetically as it should be.
The good news is that geriatrics is fascinating. From stem cells to gene sequencing, pursuing cures for Type 2 diabetes, cancer, and Alzheimer's disease, or the emerging studies of frailty, geriatrics researchers grapple with medicine's most essential questions. This work can be so exciting that medical students who gain exposure to bench research through programs such as the American Federation for Aging Research-sponsored Medical Student Training in Aging Research (MSTAR), often find themselves hooked for life.
Encouraging more medical students to pursue geriatrics research careers, supporting that research, and translating it promptly into practice for the benefit of patients everywhere must be among our highest funding priorities.
How can geriatrics help reduce health care spending? One of the most valuable (but least publicized) parts of the Affordable Care Act is its support for innovative ways of delivering care. Backed by $10 billion from the new Center for Medicare and Medicaid Innovation, the ACA promotes practices that improve clinical outcomes, and emphasizes quality over quantity of care. These include patient-centered medical homes; encouraging doctors to work in teams with nurses, social workers, and pharmacists; better coordination and less duplication of care for people who see multiple specialists; smoother transitions from hospital to home; more education about self-care for chronic disease; and more thoughtful and anticipatory palliative and end-of-life care.
These innovations are among the pillars of modern geriatric practice. By expanding their use throughout the system, we can help all health care professionals provide better geriatric care, more cost-effectively.
Most middle-aged Americans can now expect to live into their 80's and even 90's. Good news, but with that longevity often comes a proliferation of chronic diseases -- from heart disease to diabetes to depression -- the number one driver of health care costs. The management of complex chronic disease is at the heart of geriatricians' expertise. Geriatrics is sometimes compared to a long game of chess because we embrace complexity and treat the whole person in ways our colleagues in other fields often cannot, making us natural leaders in this all-important fight.
A candid doctor will admit that the satisfaction of feeling needed and useful is a powerful motivator. Perhaps this is why geriatricians, while at the lower end of the physician compensation scale, consistently report some of the highest levels of professional satisfaction and the lowest burn-out.
Geriatrics is not just important to the health of millions of older patients; it is increasingly essential to the well-being of health care in the United States. For anyone who cares about the practice of medicine, what could be more compelling than that?
Could it be driven by money and unnecessary jobs that are dependent on a 'sloppy' delivery system? This looks like just another set of what I call 'bubble-licious activities' that our society has promoted simply because it maximizes economic activity at the expense of transparency and efficiency. Perhaps we need some regulations to limit 'bubble-licious' activities to non-essential services!
And that's the reason that water, power, energy distribution, communications, food production & distribution, and health care must be treated as highly regulated activities instead of market priced deliverables. The market is everyone and everyone benefits from the control of the market.
Stop the wars and use the money for health care for the entire country......that is a no-brainer.......
The CEO of UnitedHealth made $2 billion over 12 years. Did he cure cancer? No. Just added unnecessary bureaucracy. We need to get rid of the insurance companies and use that money to put everybody on a Medicare-like system. So those insurance jobs go away. Too bad. They've far exceeded their usefulness, like rotary phones and camera film.
We also need more nurse-practitioners, DOs, and physician assistants to treat basic health issues. I am tired of going to first-line MDs who don't listen to a word I say because they've already formed a conclusion before even saying hello (and many don't even bother with hello). We need a computerized diagnostic system, like a yes/no flow chart to improve accuracy instead of depending on human memory and skill. And make participation in the universal health care system a condition for obtaining a license to practice in the US.
And then there's the pharma-mafia. It's not about curing or preventing anything, it's about making big bucks. Ever wonder why these wonder drugs seem to cause side effects and problems that are worse then what they "cure"? People need to take more responsibility through better diet & exercise instead of expecting a cure-all pill for every little ailment.
No one is worth that and it should be an outrage to everyone when we talk about the cost of health care and how we can't afford it............
People are under the mistaken notion that actual medical "care" is provided. It is NOT. The only "medical care" is pill passing and minor wound care, even in so-called "skilled nursing" facilities.There are rarely doctors in house. THAT has to change. Residents are routinely transfered out to the Emergency Department for routine tests and procedures that should be taken care of "in house".
Over use and misuse of antibiotics in the ill elderly population is only creating more "super germs.
To everyone out there with relatives in these places, some advice...visit often, and at various times. Enlist family and friends...the more often someone is there watching, the better care they will get. The more eyes, the better.
I suspect when we pass cash to each other it is also a common route for passing disease.
In my personal opinion, "Dirty" money of another sort is contaminating the entire health care reform debate.
Our system NEEDS corrective surgery. Just like in real life surgical procedures, infection from outside sources often leads to outcomes worse then the condition being treated.
Improving health care requires a sterile operating environment free of "special interest" contaminants.
My doctor is Canadian, came down here to make money he said, but is now seeing abt 65 patients a day because we lack doctors in our area....we have doctors turning away medicaid because of the low reimbursement rates, and I imagine if medicare keeps getting cut the results will be the same.
I'm not sure what the answer is, except we need more doctors, and I don't see how HCR has addressed that. So we will probably see long lines in ER's because of the lack of primary care doctors.
One thing that would improve health care is for them to make it simpler and more fraud proof.
When the government gives the health field/drug companies research they should get at least 20% of the profits on it since the rich don't want to pay taxes. They are the welfare babies of business.
The gov gave the sattelite research to the companies who charge us for every little thing. We should be getting 20% of that profit.
It is important for people to prepare their bedroom while they are physically able, in case they get 'down'.
Here is a list of what I found I needed: A small TV with ear phones, cable hookup, a laptop, comfortable mattress pads, extra pillow cases, bed sheet protection pads, a telephone, comfortable sleep clothes that open in the front, an easy to reach lamp, a night light and an intercom. Baby wipes to wash your hands, cleansing cream, makeup bag, a comb and a brush, Kleenex, tablets, stamps and pens.
One deep pill box with several compartments for bubble wrapped medicine. One set of 7 pill holders that are labeled Monday thru Friday. They are labeled morning, noon, evening, and bedtime. These help you remember, if you took your medicine.
A hospital tray purchased online that rolls and goes across you in bed. It tilts for computer use. A bed rail that fits under your mattress and you can use it to pull up to a sitting position. A recliner can be set to lay back enough to let you sleep and is easier to get out of than a bed. A mattress that you can roll up and down like a hospital bed,
Paying for insurance for people who might not need it makes us have to pay for health care even if we don't use it. Universal insurance is the wrong direction to solve the problem.
I will be 76 next month and know from experience that exercise, nutrition, relaxation, meditation and self-care can keep us out of the waiting rooms and improve the quality of lives, health and relationships for us.
Even I have been told that it is too risky for me to have a hernia operation, that I could die. They say I almost died my last operation and don't want to take a chance.
I don't know if that is their way of getting out of the surgery or if that is them being honest and caring.