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.
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
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.