MATURE MARKET HEADLINES 4/4/2001
Medicare Costs To Rise 400% by Year 2075
It's no secret that Medicare is going bust. And finally, the Feds are fessing up, flaunting the facts, and forging new strategies to rescue the nation's healthcare giant. The short-term looks tolerable, but in the long term ... well, Medicare doesn't seem to have a long term. Taken together, Part A and Part B total costs are projected to nearly quadruple over the next 75 years - growing from 2.2 percent of gross domestic product today, to 4.5 percent in 2030, and to 8.5 percent in 2075.
The Medicare trustees annual report finds that long-term trends are leading toward a much larger gap than previously projected between revenues and spending for Medicare. Long-term trends point to a dramatic revenue shortfall for the hospital fund, plus mounting costs in the Supplementary Medical Insurance trust fund that would mean steeply higher federal funding, beneficiary premiums and beneficiary co-pays.
The trustees called for changes "at the earliest possible opportunity" to address the long-term problems.
"Unless we modernize and strengthen Medicare, the long-term prognosis for this program is not good," said HHS Secretary Tommy G. Thompson. "The near-term extension in the solvency of the hospital fund is welcome, but we must not mistake it for a clean bill of health. Rather, it is a window of opportunity for us to modernize, improve and protect Medicare. We must take this opportunity now, because every year of delay will narrow our options and make the job more difficult."
Hospital Insurance Trust Fund (HI)
The trustees estimate that the Hospital Insurance trust fund will remain solvent until the year 2029, based on the most probable economic and demographic assumptions. This projected depletion date represents a four-year gain for estimated Part A solvency, from the forecast of 2025 made by the trustees last year. The trustees credited the combination of the recent robust economy, reduced utilization of skilled nursing services, and improved payment accuracy.
At the same time, the trustees reported that long-term projections of the fiscal health of the HI fund have worsened, with the gap between trust fund spending and revenues growing by 63 percent from last year's estimate. As in previous years, the shortfall occurs in part because of the growing number of Medicare beneficiaries. Today, there are about 4 workers for every Medicare beneficiary. By 2075, there will be only about two workers for every beneficiary.
Supplementary Medical Insurance Trust Fund (SMI)
As in previous years, the trustees find that the Supplementary Medical Insurance (SMI) Trust Fund (covering Part B of Medicare, which pays for physicians' services, outpatient care and other medical services) remains adequately financed into the future. This projection reflects the different financing mechanism for SMI. While the hospital trust fund relies on income from the Medicare payroll tax, Part B funding comes from general revenues and premiums paid by beneficiaries, and is adjusted annually to meet costs. This automatic financing mechanism provides guaranteed Part B funding. However, Part B spending is experiencing rapid growth, 10 percent last year alone.
Over time, SMI will require a rapidly growing share of general revenues and substantial increases in beneficiary premiums. SMI general revenues accounted for about 5 percent of total Federal income taxes in 2000. If such taxes remain at their current level relative to the national economy, then SMI general revenues will account for about 22 percent of total income taxes in 70 years.
Rising Part B costs also have direct impact on Medicare beneficiaries. In the next 20 years, the typical 65-year-old would see the portion of their Social Security check that is withheld to pay the monthly Part B premium almost double, from 6 percent to 11 percent of their Social Security check. Their total out-of-pocket expenses for Part B services (premiums plus copayments) would increase from 14 percent to 21 percent of their Social Security check.
Secretary Thompson concludes, "We need reform and modernization for all of Medicare. That must include the addition of a prescription drug benefit, plus the reforms needed to support an improved program."
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Careless Elders Don't Care for Cancer Care
What's the use? That's the typically American response to a lot of problems. Now, elder women are adopting that same response when it comes to screening for breast cancer. "What's the use?" ... they seem to say. It's gonna happen eventually. No sense worrying, or for that matter, no sense doing anything about it. And that includes not getting breast cancer preventive care.
Strange, but true. Older women who fear the possibility of becoming ill still forgo recommended routine breast
cancer screening unless they feel that they could successfully overcome health problems, according to the findings of a new Canadian study reported by the Center for the Advancement of Health.
Interviews with women, age 50 to 75, were designed to assess which factors predicted adherence to guidelines calling for women to undergo mammography every other year. Overall, more than half of the women went for routine screening. Younger women, age 50 to 69 years, were more likely to adhere to the screening guidelines than older women, age 70 to 75 years. Specifically, nearly 6 in 10 younger women were likely to follow guidelines compared to only 4 in 10 of the older women.
Despite an increasing incidence of breast cancer and the benefits of regular mammography, "adherence to mammography screening guidelines is one behavior that is poorly practiced, especially among older women," the study said. That trend was reflected in the finding that women over the age of 70 were most likely to report that there was "no need" for them to get screened.
The study also showed that women who had clinical breast examinations were much more likely to go for regular mammography screening. Having their physician recommend screening also predicted adherence to screening guidelines.
However, women who had a history of noncancer breast problems, such pain, swelling, a benign lump or abnormal mammogram were no more likely to adhere to the screening guidelines than other women. Women with family histories of breast cancer also were no more likely than those without a family history to get screened every two years.
"Although other studies have found that breast problem history has strongly predicted adherence, researchers have suggested physician reinforcement may have moderated this effect," the investigators said. "Nevertheless, the present findings support the notion that objective risk is insufficient to promote behavior and suggests that this risk needs to be personally relevant." The study is published in the April Issue of Health Education & Behavior.
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More Grandparents Raising Their Grandkids
An estimated 7 percent of America's grandparents provide extensive caregiving to their grandchildren, including more than 20 percent of those caring for the pre-school aged children of working parents, according to a study published in the April 2001 issue of The Gerontologist.
The study by Esme Fuller-Thomson, PhD, of the University of Toronto and Meredith Minkler, DrPH, of the University of California at Berkeley was based on the analysis of 3,260 grandparents drawn from the National Survey of Families and Households.
The study looked at the sample group by comparing extensive caregivers with non caregivers, occasional caregivers, intermediate caregivers and custodial caregivers.
"The fact that 6.8 percent of the grandparents in this national sample were currently caring for a grandchild on extensive basis suggests that one out of every 15 American grandparents may be doing the equivalent of almost a full-time job in terms of the hours devoted to this activity," noted Drs. Fuller-Thomson and Minkler. They added that "the denominator here includes grandparents who may be very elderly or ill, and those who are geographically at a considerable distance from their grandchildren." When the researchers looked only at grandparents who had provided any childcare in the last month, close to 15 percent were extensive caregivers. Another 24 percent of all grandparents provided an intermediate level of care.
The researchers defined extensive caregivers as those grandparents who provided 30 hours of child care in an average week or cared for grandchildren for at least 90 nights per year. Intermediate caregivers provided child care from between 10 and 29 hours a week or had their grandchild stay overnight for 7 to 89 nights.
Age of the grandchild, the researchers noted, "clearly played an important role in influencing the likelihood of extensive care provision." The study also found that 9 percent of all Americans with grandchildren under 5 were
providing extensive caregiving to a grandchild - a figure that is considerable higher than the U.S. Census Bureau estimate of 5.4 percent in 1993.
Although most grandparents reported that they were quite close to their grandchildren, Drs. Fuller-Thomson and Minkler pointed out that additional contact made for closer bonding with grandchildren. Further research into the nature and nuances of such closeness may provide a better understanding of grandparent and grandchild relationship. "The sheer number of grandparents providing extensive care to grandchildren on a regular basis
also points up the need for greater attention to the potential health and social needs of this group," Dr. Fuller-Thomson said.
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New Prostate Book Gets "Two Thumbs Up"
Each year, millions of men are diagnosed with prostatic disorders. Often they are presented with an array of treatment options, and asked to make a choice. Urologist Dr. Yosh Taguchi believes that in order for patients to make informed decisions, they must arm themselves with as much information as possible.
In his new book, "The Prostate" (Firefly Books, April 2000, $14.95), Dr. Taguchi provides everything men need to know. Writing in clear, understandable language, Dr. Taguchi:
- explains the anatomy and function of the prostate
- describes signs and symptoms of the most common problems
- explores the medical and surgical treatments available
- discusses preventive measures
- emphasizes the importance of regular checkups beginning at age 50.
Case histories, diagrams, charts, a glossary of medical terms, and a list of support groups make this detailed book an indispensable resource for men who have been diagnosed with a prostate disorder, and those who may face problems as they age.
Dr. Taguchi believes that the prostate is the source of more health problems than any other part of the male anatomy. The most common prostate problems include benign prostate hyperplasia, prostatis, and cancer.
The book concludes with guidelines to reduce the risks of developing prostate cancer and what to do if cancer is found. "The Prostate: Everything You Need to Know" is published by Firefly Books, New York, NY.
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How to Fight for Your Empty Nest Marriage
Once upon a time, people grew up, got married, had kids, and retired. Today, people grow up, get married, have kids, maybe retire, then spend another 30 years together, if they know how.
But lots of couples look at each other after their kids leave home and think, "I don't even know this person." They are now forced to spend time with each other, and they have to make that crucial transition from parent back into spouse.
In their new book, "Fighting for Your Empty Nest Marriage", authors David Arp and others show boomer couples how they can reinvent their relationship when the kids leave home. The team of five authors explore the issues and conflicts that surface after the kids grow up and no longer require so much attention. Their book reminds couples that marriage can be fun.
Empty nest marriages face eight challenges, say the authors.
- Accept each other's imperfections such as irritating habits and extra pounds.
- Give yourself time to focus on each other, not just work and community activities.
- Talk about personal matters in a way that expresses your deepest feelings.
- Use anger and conflict in a creative way that builds rather than erodes your relationship.
- Take time to relax and enjoy each other remembering marriage is friendship and fun.
- Renew romance and find ways to restore a pleasurable intimate relationship.
- Reconnect with your children on an adult level, and find balance with your own parents.
- Talk openly and regularly about what matters, where life is leading, and what it all means.
The authors also emphasize the need to watch out for the following four pitfalls in conversation with your spouse. Escalation occurs when partners respond back and forth negatively until it become hard to forgive. Invalidation is a pattern in which one partner directs painful put-downs that undermine their partner's self-confidence. Withdrawal occurs when one partner is unwilling to get into and stay with important discussions. Negative interpretations occur when one partner consistently believes that the motives of the other are more negative than is really the case.
Although the above problems can be devastating to a marriage, the authors believe that "awareness is the key". When you begin to recognize the danger signs, then you can begin to rectify them, making your future years together both happy and mutually fulfilling.
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1-in-5 Elders Need Psychiatric Care by 2010
"By 2010, there will be approximately 40 million people over the age of 65, one-fifth of whom will experience a mental illness in late life," says Stephen Bartels, M.D, President of the American Association for Geriatric Psychiatry (AAGP). "A national crisis in geriatric mental health care is emerging and action must be taken to address the impending social and economic consequences."
Bartels plans to testify before the U.S. House of Representatives and will offer AAGP's recommendations for Fiscal Year (FY) 2002 mental health research funding. His testimony will highlight the decreasing percentage of dollars within the National Institutes of Health for late-life mental health research at a time when the U.S. Census statistics are projecting that the absolute numbers of older adults will increase within the coming decade as well as the percentage of older adults as part of the U.S. population. By 2030, older adults will account for 20 percent of the total population, up from 13 percent in 2000.
Geriatric mental health research seeks solutions to a range of medical issues including late-life depression, schizophrenia, substance abuse, and Alzheimer's disease (AD). The economic impact of these diseases is staggering. It is currently estimated that direct medical costs for just one AD patient are between $18,000 and $36,000 per year, and the costs associated with the entire current population of AD patients total more than $100 billion per year.
In order to address the situation, AAGP will submit the following three recommendations to Congress.
- Funding for aging grants at NIMH increase three-fold to meet the current need.
- Review committees contain individuals with expertise in mental health and aging.
- NIMH provide personnel to support development of aging research initiatives.
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