Lessons from Professor Shalala

Article excerpt

The pressure is on. You are an undergraduate staring at the key assignment on your Aging in America course's final exam: "Write in a memo to the President of the United States about what directions federal policy should take on long-term care and hospice." And, oh yes, your professor happens to be someone who wrote many such memos-Donna Shalala, former secretary for the U.S. Department of Health and Human Services (HHS).

This exam actually did take place last year, when Shalala, now the president of the University of Miami, joined an interdisciplinary team of faculty members to offer the undergraduate course on aging. "The students absolutely loved the course, because it actually had something to do with their lives, with their future and, more important, with their relationships within their families," she said.

Shalala, who served as HHS secretary throughout both of President Clinton's terms, recounted the college class during her keynote address at the annual conference of Grantmakers in Aging, held in Miami in October 2004. She discussed a wide range of concerns in aging, from the Medicare prescription drug program to the need for age-friendly communities.

Evidently, Congress would not have earned a passing grade from Professor Shalala. She declared the Medicare Modernization Act of 2003 a mess. She continued, "I recently told Bill Clinton that I'm not sure my team at its best could have implemented that program-it is so complex." Not only have the complexities of the interim program offering prescription-drug discount cards deterred most older people from signing up, she explained, but also-when the full program takes effect in 2006-"seniors are going to have to pick their pharmaceutical benefit before they know whether a plan covers the drugs they are now using. That's insane."

Furthermore, only days prior to the November presidential election, Shalala commented, "Neither candidate fully understands what it means to grow old in America and how we make these programs more complex than they need to be. They're not user friendly." For example, she said, for many older adults, "The problem with the Medicare program is that we've added so many requirements that it's getting increasingly complex to use. The pharmaceutical benefit is actually in danger of not being used because of the choices seniors have to make." Medicare, she said, has to do more than offer an informative website because "most seniors aren't on the computer."

More broadly, Shalala questioned recent projections showing excessive growth in the cost of Medicare and related health programs. She noted, "In the 19908, healthcare costs weren't growing in the big programs as fast as private healthcare costs. There actually are ways to contain these costs and certainly to contain their growth, but there are also ways to make healthcare affordable and to put more emphasis on prevention."

The United States, she said, will "get some control over healthcare costs, not just through technology but also through lifestyle." For example, younger people are smoking less, and getting people to walk more can reduce obesity. However, she said, tort reform, a major goal of President Bush, might have little effect on health spending. There is little evidence that "tort reform has that much of an impact on healthcare systems. There's just a lot more technology in the system."

Shalala observed that mounting evidence shows high levels of obesity in the United States are not only a matter of genetic inheritance, but also are related to lifestyle. She stated, "Active aging is no longer a quaint phrase but is directly related to healthcare costs. …