Medicare: paying for stupidity
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Thorpe and colleagues found more than half of all Medicare beneficiaries are treated for five or more chronic conditions each year — such as diabetes, arthritis, hypertension and kidney disease — and 99 percent of every healthcare dollar spent in Medicare goes for treating patients with chronic conditions.
Pardon my bluntness, but this is stupid. Stupid because I suspect they’re right, and stupid because most of these chronic conditions are preventable.
Let me be quick to point out that many chronic diseases — type 1 diabetes, for example — are not preventable, at least, not that we know of. Certain cholesterol problems are genetic, as are certain blood pressure disorders. These represent a minority of chronic diseases.
Let me also be quick to point out that I’m not wagging my finger at those who have the preventable forms of chronic diseases. It’s likely that you were raised in a society that laughed at you for or discouraged you from exercising regularly, that provided horrific food more cheaply than healthy food, and that placed necessary medical care financially out of reach. In fact, you’re still living in that society, if you’re an American.
Health care reform cannot exist without strong attention to preventive healthcare behaviors. Preventive medicine plays a role, as well, but is not nearly as important as day-to-day choices. As part of healthcare reform, we need to make healthy behaviors the path of least resistance. Encouraging people to make bad decisions and then paying through the nose for it later will only make the situation worse.
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Dr. McNamee,
You are of course correct that it is probably true that a huge portion of the Medicare patients are being treated for preventable chronic diseases and that there could be significant health benefits (and cost savings) if these preventable diseases were, well, prevented. However, it has to be pointed out that every single Medicare patient is at least 65 years old. Old people in general suffer from chronic diseases much more than younger people do. Some of chronic diseases that Medicare treats are Alzheimers disease, osteoporosis, arthritis, diabetes, COPD, strokes, and vision & hearing lose. Certainly, some of these are preventable but others are not. However, there is nothing that can be done within the structure of Medicare to do preventative medicine since Medicare treatment does not begin until the chronic condition already exists in a very significant number of cases.
While I agree that preventing chronic diseases would be much better than treating chronic diseases, I do not see that given the very limited nature of the current efforts at health care reform, it does not seem likely that much will be done along these lines. It would take a much more comprehensive reform to address these issues.
I agree with your comments about much more comprehensive reform being needed to address these issues. And while you’re right that older people suffer from chronic diseases much more than younger people, many are still preventable — not via a Medicare-based intervention, which would obviously be too late, but by measures set in motion well before the chronic condition set in.
In response to another comment. See in context »