Most of us, or at any rate, most of us in the health professions, tend to look at an aging society from the standpoint of its health. However, few of us consider the social, political, and clinical impact of a rapidly growing, heavily entitled cohort of aging people—the Baby Boomers—who already are characterized by political activism. But now this voting block, all 76 million of them, is more united than ever: rich or poor, educated or illiterate, of all races and of both parties and genders face the same issues and have roughly the same entitlements, including Medicare. And they have every reason to want to preserve the entitlements intact!
For three decades, some of America’s best minds have been working on solutions to the coming crises in Social Security and Medicare, but Baby Boomers will have the time, the money, and the political know-how to counter any threat to their benefits—facts we must keep in mind as we consider the following experts’ suggestions:
1. Put a reasonable “back end” on Medicare benefits (there currently is none). A lifetime Medicare benefit of $500,000 does not seem out of line. Private policies have a back end to limit exposure: it is only commonsense for government to do the same.
2. Stop encouraging individuals and families to expect “futile care.” In fact, don’t even offer it! Futile means care that can’t help: why do we offer anyone what cannot help? In addition to saving untold useless suffering, elimination of futile care would reduce expenditures by about 12.5%.
3. Mr. Obama, take note: Give up our failed experiment in market-based health care “reform” in general. Create a one-payer system! Increase Medicare’s risk pool to help ensure both its fiscal viability and the quality of care provided. No private insurance agency would offer a policy that covers only high-risk patients (and requires an act of Congress to increase the premiums). To pay for the expansion of service to all Americans, the Medicare tax should be expanded, and other public plans and all large employers (over 100 employees) should be required to participate.
What would such changes mean for nurses? Lots of opportunities! What would they mean for the public? Universal access! What would these changes mean for the health care system? Radical restructuring and a dramatic decrease in overhead costs. Who favors it? Just about every organized body in health care from the American Nurses Association to the American Medical Association to the American Hospital Association!
Who opposes it? Opposition comes from the most powerful lobby in America: the elderly…and, if it’s politics as usual, we will have a gerontocracy.