May 3, 2009

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Mr. Obama, what are you thinking?

Back in 2000, when my father was dying – but desperately wanted to die at home – we talked about the cost of ’round-the-clock’ care for him. And he said, “Leah, I can’t spend that money. I’m saving it for a rainy day!” And I said, “Dad, it is raining. Now. And it’s raining about as hard as it’s ever going to rain.” Well, Dad ‘bit the bullet’ and forked over the dough. What brought that story back to me was the combination of our economic crisis, the aging of America, and the costs of health care (or to be more exact, illness care.) Barack Obama speaks eloquently of change…and that includes in healthcare. And not everyone will like the changes. And not everyone will benefit from the changes. By 2017, one dollar out of every five spent in America will go toward healthcare costs according to a report in Health Affairs. Let’s look at a few fairly well-established facts:

  1. With all the lay-offs, we have an unemployment rate of about 7% and some pundits say it will rise to 10% by the end of 2009 (that means 10% fewer people paying into either Social Security or Medicare).
  2. The average one earner couple retiring today will get about $123,000 more out of Social Security than they and their employer put in. Omit the employer’s contribution and the windfall rises to $173,000. With Medicare included, it rises to nearly $310,000, much of it tax-free.
  3. FICA contributions have never been saved by the government. Its ‘assets’ consist of Treasury IOUs. The federal government has already promised today’s adults $8.3 trillion in future Social Security benefits beyond the value of the taxes they have paid to date!
  4. By 2040, the cost of Social Security as a share of worker payroll is expected to rise to 22%. Add both parts of Medicare (which currently cost about 5.3% of payroll) and benefits for seniors will consume 35 to 55% of every workers paycheck. And this prediction was made before the Great Recession!
  5. In the last century, life-expectancy of the average person increased by 30 years. Of that amount, 25 years is attributed to public health measures, and 5 years is attributed to clinical medicine – most of that due to prenatal and childhood care. Today with massive amounts of medical technology, Medicare adds only about one year of additional life that can be attributed to clinical medicine. And that additional one year of life cost about 335 billion dollars in 2006 in the USA.

One wonders what Barack Obama might do to meet this crisis. Unfortunately, his healthcare plan is strong on vision but short on details. The one element of Obama’s plan is his call for major expansion of the government’s role in improving the quality of care. Obama’s plan would link payment with reported quality. A New England Journal of Medicine article claims that 31% of health care expenditures in the US went for administrative costs. Obama’s plan also calls for a ten billion dollar federal investment in healthcare information technology over five years to improve quality and save money. So, in practical terms, what might this mean?

(a.) Reform entitlement programs (affluence test to progressively reduce benefits to households more than $5000 above the U.S. mean household income.

(b.) Raise the eligibility age for full benefits to 72.

And (c.) Set limits on Federal Spending (a back-end on Medicare)…

What do you think this might mean for the Health care system, nurses and nursing care?

7 thoughts on “Mr. Obama, what are you thinking?”

  1. Jessica (3) says:

    The government can pool risk and establish incentives for heath care providers to find new ways to provide better patient outcomes at lower costs (Shortell & Casalino, 2008). It won’t be an easy task to come up with an idea that pleases the majority of the legislators or the public but it is imperative that we do something to stem the rapidly rising costs.

  2. Jessica(2) says:

    We, as nurses, are able to use our emphasis on education to educate the public about living healthy and changing their lifestyle. But, besides the reform that needs to take place within the public attitude, there also needs to be reform that comes from the top down. The government must recognize the failures of our current healthcare system and address them directly.Reform is necessary and it will take government action in order to initiate the change that is needed.

  3. Jessica(1) says:

    I believe that it would be nearly impossible to create a system in which we satisfy everyone’s wants and needs but it is possible to create a system that decreases wasteful spending and increases the focus on health instead of illness. Slowly our country has begun to shift focus and realize that health and wellness are the best prevention we can have for obesity, cancer and other chronic, terminal illnesses.

  4. Michele says:

    Obama’s Health-Care Reform plan would focus on prevention, so “nurses won’t have to treat diseases … that could’ve been avoided” and calls for health records to be modernized. The NIH reports that obesity, associated with chronic conditions, is due to social, economic and behavioral factors. The EMR system proposed has been shown to increase documentation time by 15.8% initially, necessitating increases in staff and budget (Health Informatics, 2005). Nurses will not benefit from this reform.

  5. Leah says:

    Anonymous doesn’t think government control is the answer – but offers no insights. As it stands right now, the government is already paying over 60% of all health care costs (Medicare, Medicaid, CHIP, Military benefits etc). With the aging of he population (and thus the increase in Medicare beneficiaries)alone, the government will be picking up over 75% by 2020 and this with no change…just lots of profiteering in health care should bankrupt the system. Government ‘control’ is a necessity!

  6. Jeanne Clement says:

    I agree that the future of Medicare–or what ever takes it’s place is certainly shaky particularly as the “boomers” come fully into their “golden years” with little sense of the actual cost of illness care for the chronic illnesses whice are endemic. The push for prevention and life style change wi

  7. Anonymous says:

    More government control in health care is not the answer.

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