Recently the Wall Street Journal carried an article headlined “Proton-Beam Treatment for Prostate Tumors No Better Than Radiation” referring to a paper published in the Journal of the National Cancer Institute.
Actually the results indicate that while they could see no long term benefit, there was a short term incidence of problems with urinary function. So there is a benefit and the real issue is that the cost of the treatment is hugely more than radiation. If the costs were comparable, the headline would be different. In an earlier article the WSJ reported that “Medicare patients rack up disproportionate costs in the final year of life. In 2009, 6.6% of the people who received hospital care died. Those 1.6 million people accounted for 22.3% of total hospital expenditures.” Of course, it’s difficult, if not impossible, to determine before the start of treatment, exactly who will die.
It is pretty clear that many of the issues are economic, not clinical. The reality is that people are living longer and that, no matter how much you can drive down the cost of treatment, the longer you live, the more service you’ll use. It’s also the cost that new medical technologies help people live longer, exacerbating the problem. If that’s the case perhaps we should adopt the practice of Senilicide (the killing of old people) in a manner similar to that which was reportedly practiced by some of the Inuit. That would be one way of dealing with Medicare financing.
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Perhaps a slightly less repugnant way is to stop covering medical services when someone reaches a certain age. Of course that’s inhumane. The point is that, as long as we pretend that it’s not a care – and – cost issue, the less we’ll be able to deal with the realities.
We’re not going to, nor should we try, and stop science from finding new and sometimes expensive new interventions. While science may find some expensive treatments unnecessary and some low cost innovations may be shown to be effective, I don’t believe that can sufficiently offset the costs of new discoveries and the fact that people are living longer. I know that there are those who cite the lower cost of care elsewhere. That’s a function of perception, culture and psychology and is difficult to change. There are others who are focused on healthy behavior, health maintenance and disease avoidance. That’s a function of habit and lifestyle and will take longer. We need to think about what we can do now.
The facts are that people are living longer, staying younger longer and, when older, stay sick longer. It seems to me that keeping the retirement age at 65, or even below 70, is unrealistic and impractical. Synchronizing Medicare eligibility with this work reality doesn’t seem radical. The recent resurrection of the controversy about raising eligibility age to 67 as part of deficit reduction seems to me more associated with managing who would pay than any reality.
Raising the retirement age and the associated governmental benefit programs for those healthy enough to work makes sense on a number of fronts. It helps the government’s entitlement programs, it deals with looming broader fiscal problems and it helps keep productive people being productive longer.
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Albert Shar, Ph.D., is managing principal at QERT (qertech.com), a technology consultancy that works with businesses providing expert advice in the strategies necessary for success in today’s rapidly changing and competitive healthcare environment. Prior to QERT Shar was VP for IT and senior program officer for the Pioneer Portfolio at the Robert Wood Johnson Foundation (RWJF) where he helped developed innovative approaches to the uses of technology in transforming healthcare. Previously he was director for IT Research and Architecture at the R.W. Johnson Pharmaceutical Institute, a Johnson & Johnson company. Shar was director of technology services at the University of Pennsylvania Health System, and CIO of its Medical School. He has held a number of faculty positions at the University of Pennsylvania School Of Medicine (Pharmacology and Gastroenterology), University of New Hampshire (Mathematics and Computer Science) and the University of Colorado (Pure and Applied Mathematics). Shar was a visiting professor at the ETH-Zurich FIM and holds a patent in medical imaging and is the author of more than 50 articles in healthcare, computer science, and pure and applied mathematics.
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