Thursday, April 30, 2009

Patient views - Rising Expectations of the "Near Old" as an Obstacle to Cutting Health Costs

The Revolution of Rising Expectations

Harland Cleveland, title of speech

New drugs ease pain, reduce depression, manage hypertension, control cholesterol, improve sexual function, and generally make life livable for millions of Americans. New technologies quite tremors, replace failed joints, keep diseased hearts beating, and hunt down errant cancer cells. New scanning procedures allow physicians to view the body through incredible imaging technology that much likes magic as science. Every single one of these new and wonder care improvements costs money, and most cost a lot of money.

George Halvorson, George Isham, MD, Epidemic of Care, Jossey-Bass, 2003

Critics of American health costs complain we spend 30% of Medicare dollars on the last illness. What they don't say is: we spend even more restoring function to the “near old.” Someone has grandly divided aging into the very young old (55), young old (65), middle old (75), and old old (85). But most of us naturally think of ourselves as the “near old,” meaning not old yet. As the saying goes, you're only as old as you feel.

We “near old” have high and rising expectations of what health care can do for us. This is America, and we expect quick access to those life-style and youth-restoring half-way technologies that make us feel and function as the near-young again.

I often ponder the rising expectations of aging America as I walk, talk, and balk at the aging process with my male friends each morning at our coffee clutch. All of us are over 60, all of us think of ourselves as high functioning seniors. All of us have experienced American medical care's wonders, and all of us expect to continue to have prompt access to these wonders.

There are 10 of us. As an exercise, I’ve jotted down what wonders the 10 of us have experienced and are experiencing.
• Currently taking statins 8/10

• On hypertensive medications 6/10

• Stent, coronary bypass, 6/10
pacemarker, or other device

• Cataract surgery 3/10

• Drug for hypertension 5/10

• Invasive surgery 8/10

• Joint replacement 3/10


Growing old and infirm used to be very hard. It means faltering parts and a Medicare card. Now, thanks to Medicare and medical technology, along with replacement parts comes a new psychology. When you’re going like sixty again you don't feel like part of the fading old Guard. The rising expectations of the near old for quick access to the wonders of modern technology will make it hard to cut costs as part of the health reform effort. This is America, the land of equal opportunity, and a shot at the best.

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