No Medicare for you!

Anyone under 30 should fully expect to never see a Medicare dollar to help pay for health care when they reach the appropriate age.  As continued evidence of those slimming chances “60 Minutes” reported last night on an effort to increase both quantity and quality of life through Resveratrol—the substance found commonly in red wine:×3.swf
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The implications of an extended life are large for Medicare—even if the promises include a reduced prevalence of disease.  So any health care reform must be adaptable…isn’t that a big part of the problem now?  A reimbursement system founded on the health care delivery realities of 50+ years ago?  Science has advanced, the way we pay for that science needs to as well.

Our Future: Moving Back Home?

Give or take a few years, the Millennial generation is roughly composed of those born between 1980-2000.  We number over 80 million (yes, that’s more than the number of Baby Boomers).

The eldest of this generation are starting to become parents.  Parents of Millennials are nearing retirement.

Explore this: in 15 years, the oldest Millennials will turn 43.  If they had children at 30, their oldest will turn 13.  The parents of those Millennials will largely be retired.

What’s the big deal?

From The Wall Street Journal’s Real Time Economics blog:

The study, by the McKinsey Global Institute, the think-tank arm of the consultants McKinsey and Co., carefully examined the saving behavior of various generations. The “silent” generation, the 52 million Americans born from 1925 to 1944, followed the classic pattern closely, with their household savings rate rising from below 15% in their early 20s to about 30% in their late 40s. But that pattern is almost absent for early boomers, those born 1945 to 1954; their saving rate tops out about 20%; and it’s completely absent for late boomers, those born 1955 to 1964, whose saving rate so far has remained stuck at around 10%.

Combine that with this troubling story from LifeWire via CNN:

When Stephen Leach gave up his Rockaway, New Jersey, condo at age 48 to move back in with Mom and Dad, it was out of need — his parents’, not his.

With his father suffering the ravages of Alzheimer’s disease and his mother struggling to remain in the large Randolph, New Jersey, home in which they raised five children, Leach stepped in a year ago to stabilize matters.


Such arrangements are becoming more prevalent as the population ages. An estimated 10 million American adults need help with daily activities, and family members are responsible for 80 percent of such caregiving, according to the AARP.

If the people who supposedly saved enough are having trouble paying for health care in retirement, what lies in store for the Baby Boomers who most assuredly have not?  What are the implications for their Millennial children who may incur the burden of taking care of both their parents and children simultaneously?

Expensive health care has ramifications (see above) far outside its sheer cost.  But money has the most prescient impact.  Our health care spending becomes more difficult to sustain every day.  It is expected (pdf) that there will be 2.9 workers for every Medicare beneficiary by 2020, down from 3.9 in 2003.

A sustainable health care future is desirable for all.  Eighty (plus) million Millennials will think along the same line.  The last thing we need is a parents vs. children struggle for government dollars.  Expensive health care could ignite just such a fight.

Are physicians risking their seat at the Medicare table?

Last week the United States Congress chose physicians over insurance companies in overriding a presidential veto of a bill that repealed Medicare fee cuts by 10.6 percent.  The measure, in large part, was a move to save health care accessibility for seniors.

From The New York Times:

The vote “renews the light of hope for those who need our help the most, senior citizens who depend on Medicare,” said Senator Harry Reid of Nevada, the majority leader.

It seems a light of hope was all it was for some seniors.  This from Anne Zieger at Fierce Healthcare:

With Medicare cuts looming, many physicians vowed that they’d stop accepting Medicare patients entirely if and when the cuts went through. The thing is, even though Medicare cuts have been held off, large numbers of physicians are dropping out anyway. One example of this comes in Tennessee, where doctors are increasingly dropping out of the program. Not only are many refusing new Medicare patients, some are thinking about dropping current Medicare patients too. That’s because in some cases, doctors aren’t even getting paid enough to cover their expenses, they say.

While the bill that prevented fee cuts does nudge reimbursements up just a bit, the problem of low reimbursements has been well documented, especially for primary care physicians.  In fact, we’re less than 18 months away from another fee cut, this one topping 20 percent.  Some think a completely new approach to Medicare is needed—such a measure is likely necessary to save the Medicare program.

Amidst promises by physicians to stop accepting Medicare patients should the cuts have remained, politicians prevented such a catastrophe from happening.  But some physicians have reversed course.

Are physicians risking their place at the table when new Medicare payment policy is formulated?

Too soon to tell.  Granted, physicians need to support themselves and adding minuscule incremental fee increases doesn’t fix already notoriously low reimbursement schedules.  But are doctors risking their credibility with politicians, who supported them by preventing this year’s version of the traditional Medicare fee cuts, by not accepting or dropping Medicare patients?

Unlikely since Medicare needs physicians in order to make the program work, but it’s worth a discussion.

In politics, leverage is everything.