Sunday, September 05, 2004

Medicare, Medical Technology and our Aging Population

Medicare premiums are going up. That's the big news. The Democrats will attack Bush on this and the Republicans will try to dodge it. What no one will address is the structural problem, the glaring flaw in the very idea of Medicare.

It started as part of LBJ's Great Society in the 60s. Through Medicare the federal government would pay to treat senior citizens, age 65 and over, of their illnesses and conditions. It was all very well-intentioned.

However, 40 years later, people live much longer, the list of treatable illnesses and conditions has greatly expanded, the population of seniors has grown and the medical technology has produced a vast array of complex and expensive treatment options, including drugs, devices, and surgery. But the definition of Medicare has not responded to these changes. The age of enrollment is still 65 and we still do not means-test those who are eligible. Costs rise in part because of the 'scope-creep' of the program itself. Every year it covers more people with more conditions and treats more illnesses with more technology. Hence it costs more.

What we have is a program that promises to serve any senior with any medical treatment in perpetuity. We have to ask ourselves: Who should Medicare not cover? What conditions should Medicare not cover?

We often hear that X is the Number One killer of this or that group. There will always be a Number One killer. People have to die of something.


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