Red Tsunami

Great Wave unrestored

Image via Wikipedia

A tsunami doesn’t behave like I used to think.  I used to think of it as an approaching wall of water, but now that I have seen the clips from Japan I realize it is more like an oozing tide that starts out shallow but rapidly deepens as it carries all manner of debris and structures forward in a crushing, chaotic torrent.  Such an image is relevant not only for disaster planning but as an analogy for another disaster that is already engulfing us.  I’m talking about healthcare costs.

Healthcare costs are recognized as a major problem, but their effects are being underestimated because projections do not include the amplifying effects on caregivers.  I am prompted to this depressing view by a column in the March 16, 2011 edition of USA Today a psychotherapist writing in vivid, no-nonsense clarity about dementia.  She says,

We all hope never to endure having our minds slowly diminished and devoured by dementia, but the odds of that are worse than you might know. In fact, there’s about a 40% chance that your brain is programmed to self-destruct while you’re in your 80s. Your chances of developing dementia increase steadily every year.  Almost 13% of those 65 and older already have Alzheimer’s disease, which is only one of many forms of dementia. As the Baby Boomers age, the number will increase astronomically.  This coming, unprecedented surge threatens to overwhelm individuals, families, medical systems and budgets.

She then adds,

The caretakers who will be responsible for us as we descend into silence and dependence are young and middle-age families. They will sacrifice their own lives and livelihoods to such an extent that by the time we die, 72% of them will feel relief, according to a 2006 study published in The Gerontologist. In the early stages, family members provide about 22 unpaid hours of care per week. By the end, round-the-clock care is necessary, forcing family members to reduce working hours, take unpaid leave, or quit their jobs.

In 2011, the medical costs of American dementia patients will come to $183 billion. The care provided to them by family and other unpaid caregivers was valued at $202 billion, for a total annual cost of $385 billion, according to the Alzheimer’s Association. Unless effective treatment and prevention can be found, by 2050 the number of Americans with dementias will triple to nearly 16 million, while the medical costs of caring for them will balloon to $1.1 trillion per year.

 

U.S. Healthcare Costs, % of GDP

The author’s plea is for more funding for dementia research, but her message is clear as to the financial implications.  The economic, physical and emotional ramifications for caregivers are compelling.  Consider then that the effects of the aging of the Boomer generation and the obesity epidemic are similar, the principal outward symptom being physical incapacity demanding caregivers and expensive medications like statins, oxygen and electric carts. If Dante Alighieri were alive today, he would doubtless add this healthcare image to his inferno.  It deserves its own circle.

 

This means that America is already feeling the initial surge of this financial tsunami.  To face these facts is to peer into an ugly future.  The accelerating nature of it has been underestimated in my opinion because of the effects on caregivers as so well described in the dementia article.  In answer to some

Healthcare Costs, % GDP, by Country

comments on my previous post,“Boiling It Down”, I am including some charts that do not take that factor into account and are therefore probably optimistic.  But they are bad enough.  Shown are healthcare spending as a percent of GDP in the U.S. and how our costs have risen relative to other countries.

The fundamental problem is a failure to face costs realistically, and the visible face of that denial is encoded in the EMTALA law. We need to have a serious national dialogue.  The dirty water is already around our knees and it’s rising rapidly.

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About Jim Wheeler

U. S. Naval Academy, BS, Engineering, 1959; Naval line officer and submariner, 1959 -1981, Commander, USN; The George Washington U., MSA, Management Eng.; Aerospace Engineer, 1981-1999; Resident Gadfly, 1999 - present. Political affiliation: Independent, tending progressive as the GOP recedes from its Eisenhower roots.
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6 Responses to Red Tsunami

  1. Duane Graham says:

    Jim,

    Disturbing, indeed.

    No doubt the problem is great, but not insoluble. In looking at your graph showing health care costs as a percentage of GDP, I looked at that rate in 1960, 5.2% (The CBO estimates it at 4.7%) I wondered to myself just how folks in 1960 would have reacted if someone told them that in fifty years, we would more than triple that number? I can imagine the response would have been, “My God, what are we going to do?”

    Likewise, there is concern now, and justifiable concern, that the future looks problematic. Just what the solution is makes the debate, doesn’t it? Right now, I believe a majority of health expenses are still paid by private sources, and for sure most of the public money goes to private providers. So, for whatever it’s worth, we do have some comfort in knowing that the money spent is stimulating the larger economy. It is providing a lob of good jobs out there.

    In any case, your post has made me want to do some more research on the data and look at the solutions that have been proposed. I’m still predisposed to go for a single-payer system of some kind, or some other European-styled system, since your graph shows their costs are significantly lower than ours. In that respect, they must be doing something right. But I’m open to whatever has been proven to work, not a scheme devised by those devoted to the inerrancy of the free-market system. We have chosen not to treat health care as a commodity like corn, as your point about EMTALA demonstrates.

    Thanks for the post.

    Duane

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    • Jim Wheeler says:

      The most I am hoping for now, Duane, is to get people’s attention, and I’m gratified that you are receptive. As I recently told another blog commenter, I have relatives who work in the healthcare system and so I know first hand that its financial condition is not, well, healthy.

      A single-payer system may well be the answer and I am not opposed to it. In fact, we may be easing into it even now. Already the nation’s hospitals are getting more than half their income from Medicare, Medicaid and veteran’s programs. Whatever system we evolve to, I suspect it will make more use of Physicians Assistants and the like and that doctors will be earning less than they do now.

      Thanks for the positive comment.

      Jim

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  2. ansonburlingame says:

    Jim and Duane,

    Remember the song “16 tons”. “One fist of iron and the other of steel. If the right one doesn’t get then the left one will”.

    Now consider health care using the followin anecdote.

    A person, using “free health care” provided by the government discovers that he/she has a brain anueryism, small but detectable. Without the free care the problem would never have been identified in the first place. The person is then placed on a “watch” to monitor the growth, over years on the anueryism. As a direct result of such “monitoring” a disabling stroke occurs. Next step brain surgery, maybe. All of it is “free” with cost not being a factor for anyone.

    Suppose, following “free” brain surgery he/she is “cured”. Great medical science eveyone says and the patient deserves only the best AND “free” care.

    BUT, the patient has a family history of Alzihmers Disease. Now that the patient has been ”cured” of one problem there is a reasonable statistical chance that the patient will become a statistic in your dementia charts.

    Without the above “cure” for the anueryism, the patient may well have lived for a “normal” life and died suddenly much later with a ruptured anueryism, a “quick and sudden” death rather than the angony of encroachin dementia. And the patient and the family would never have known of the “ticking bomb” remaining undetected and untreated. No stress in that situation.

    Now which is more humane?

    And which process costs far more than any family can afford?

    Now go cure cancer at whatever cost (huge) it may take. The “left one” won’t get you in that case but there is always a “right one” waiting in the wings.

    At what cost does medical science extend life, how far does it extend it and in the end what is a more humane result? And what exactly is the purpose of such extension of life? So everyone has the “benefit” of staggering around with a walker, drolling on their shirts and being followed by a caregiver holding a bed pan, with all of the above taking place in a “facility” far from home or familar surroundings?

    And for now at least that final stage of life is NOT “free”. Rather it drains everything out of family coffers “humanely” unless the patient has some “extra” benefits provided by “somebody” at great cost as well.

    Go walk through an ICU and check the age of many patients therein, with many hooked up to life sustaining equipment. And cost is not an issue today for any of those sad folks and families, at least until they are discharged to a nursing home. And somehow we as a society convince ourselves that is the humane way to “live”.

    Given a choice would most folks pick a quick, sudden and unexpected death at say age 70-75 and no cost or very little to the family, or a long, painful and linering death at age 85-90 at huge cost to eveyone concerned?

    Then factor in relatively pain free hospice care or even euthanasia as a choice to a patient and/or family versus the alternative while waiting, painfully and costly for the “right one”?

    No biblical references on the latter suggestion, please. Just an observation of what some reasonable people MIGHT choose for themselves or their family IF the government would allow such choices.

    Anson

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    • Jim Wheeler says:

      Anson,

      We are of course aware that your words here are inspired by some personal experience.

      A recent news item celebrated that the average lifespan has reached age 78, a new milestone for American medicine. But this has nothing to do with extending our natural biological clocks. The gain comes from improvements in things like prenatal care, vaccinations, early-detection programs and expensive cardiac interventions like stents and valves. All this only makes dementia the more likely cause of the inevitable, thus reinforcing the point of my post. The red tsunami accelerates.

      I believe the conundrum you pose makes an excellent case for retaining the counseling option in the ACA which the GOP disdains as death panels. Do you see any irony here? Maybe the Pelosi Prophesy is coming true. Your ICU tour would reveal to anyone taking it that God is not going to solve the problem for them, but education, counseling and some realistic backbone can, so I fully agree with you about hospice. It is under-used from what I hear.

      Jim

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  3. Jim Wheeler says:

    @All,

    As if to emphasize just how much control some of us still have over how our individual lives will end I just came across this dramatic statement in an online AP article about radiation:

    As bad as Chernobyl was, the average radiation dose over 20 years to people who live in contaminated areas was “relatively low” — 9 millisieverts, nearly the equivalent of a CT scan — once the short-term doses to the thyroid were subtracted, the UN report said. That means there should not be “substantial health effects in the general population that could be attributed to radiation,” the report concludes.
    The NRC has said that typical annual background exposure to radiation shaves 18 days off the expected lifespan. Working in a nuclear plant under ordinary conditions — not in a crisis like the one unfolding in Japan — shortens life expectancy by 51 days. By comparison, being 15 percent overweight cuts two years; smoking a pack of cigarettes a day costs six years of life.

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  4. ansonburlingame says:

    Jim,

    We are in agreement on both points. And note that Japan is NOWHERE CLOSE to a Chernobyl disaster. I am still trying to find out if it is worst than TMI with no answers yet.

    I would only add euthanasia to the list as well with the ONLY person or people making THAT decision being the patient or family with sound and several different sources of medial advice, apolitically provided.

    You and Molly might well make a different choice than Janet and I would make in such circumstances which is fine and I would NEVER criticize anyone’s choice in such matters, one way or the other. But GOVERNMENT should stay out of it entirely other than paying for the sound medical advice above as long as government pays for any health care or EOL decisions without politics of religion entering the picture.

    Anson

    Like

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