Healthcare and Entitlement: Can We Bend the Curve of American Optimism?

By Rosenblatt, Robert | Aging Today, September/October 2009 | Go to article overview

Healthcare and Entitlement: Can We Bend the Curve of American Optimism?


Rosenblatt, Robert, Aging Today


Potomac Sources

Americans are optimistic that our nation's medical establishment can find treatments and cures for every ailment - and that we, as Americans, deserve unlimited access to this expertise. We want all that medical science can do, regardless of how much it costs and whether it is in fact effective.

This optimism may make it impossible to slow down the growth in national health spending (now referred to in Washington as "bending the cost curve"). The popular response to proposed healdicare cost-cutting measures is that "it seems like a good idea, but not when it touches me or my family."

The tab for healthcare will keep growing as the U.S. population ages: Older people develop more medical problems, utilize more procedures and consume more medications. Today, mere are 38 million people over age 65 - a number that will double by the year 2030, when even the youngest members of the baby boom generation will reach age 65.

It's vital that this population (and the taxpayers) get their money's worth. But we are not heading in diat direction.

A GAPING CHASM

The American public seems to want access to ever more medical procedures and treatments: Sixty-seven percent of people polled say that Americans don't get all die tests and treatments they need, according to a Kaiser Family Foundation report. And, if a doctor recommends a treatment for a patient, health insurance should pay the full price for it even if there is a cheaper treatment that is just as effective, said 55% of the poll respondents.

There is a gaping chasm between the public's desire for unlimited resources and the most effective use of medical science. In polling, only 16% of Americans says they have been given unnecessary care. The experts, however, believe as much as 30% of medical care is unnecessary.

"Experts believe the healthcare system is full of unnecessary care and troubling variations in care, and are committed to the long-term reform of the healthcare delivery system to make it more efficient, smooth out variations and produce greater value for the healthcare dollar," writes Kaiser Foundation president and CEO Drew Altman in a recent essay. "The public has a very different world view. People think that underservice is a bigger problem than over-service."

QUESTIONS OF CHANGE

The federal stimulus package that passed early this year includes $1 billion for comparative effectiveness research, including $400 million for the Department of Health and Human Services. The money is earmarked for determining the best ways to treat various medical conditions, but it is questionable whether any findings will be used to change our nation's medical system.

People in Washington with long memories recall that in the 1990s, the Agency for Health Policy and Research proposed that back surgery was not always effective in alleviating back pain and that other treatments, such as medication, might do a better job.

In response, back surgeons staged a determined lobbying effort, which caused the agency's budget to be slashed. The recommendation about alternative treatments to back surgery was immediately dropped.

The use of CAT scans has quadrupled since 2002. Though it is true that these scans can enhance a doctor's understanding of a patient's internal (and overall) condition, it is unknown whether the prevalent use of scans will, in the long run, make for a healthier populace.

Interviewed for Reuters, Dr. Michael S. Lauer, director of the National Institutes of Health's National Heart, Lung, and Blood Institute, says that "the problem... we have here is that we don't know if there are too many [tests given], too few or just right." Lauer states mat "only a few imaging tests - mammograms for discovering breast tumors, ultrasound of the abdomen for diagnosing aortic aneurysms - have been scientifically proved to save lives. …

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Healthcare and Entitlement: Can We Bend the Curve of American Optimism?
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