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Often described as the demographic "pig moving through a python," the baby-boom generation has always exerted a huge influence on American society and institutions. And according to a new book from the Indianapolis-based Hudson Institute, when members of this cohort start to reach their "golden years" in the early 2000s, their sheer numbers will force permanent changes in the nation’s health care delivery system — changes that will not necessarily be for the better.
In about 100 pages of very readable text, Health Care 2020: The Coming Collapse of Employer-Provided Healthcare, co-authored by William Styring III and Donald Jonas, details how social, political, and demographic trends will affect the financing and methods of organization of the health care delivery system in the United States. When the 76 million-strong "boomer generation" enters the new millennium, "They will be retiring in droves, straining employer health plans, as well as bankrupting Social Security and Medicare," Styring said in a news release announcing the book’s publication.
Meanwhile, in the realm of health care treatment and delivery, "The emphasis will be on cheaper care for the elderly, such as home health care," said Jonas, who adds that "kidcare" programs "will suffer as more and more money is spent on the elderly majority population."
The ratio of elderly/retiring boomers to younger/working "baby bust" individuals will hit the 3-to-1 mark in 2020, down from today’s 4-to-1 level, according to Styring and Jonas. This ratio will further decline to around 2-to-1 by 2030. By then, if post-boomer workers are called upon to pay for all the health care their elders demand (and indeed subsidized for the generation that preceded them), the United States will experience societal strains "as powerful as this country has seen since the slavery question erupted into a civil war."
"The bioethics debate will become a bombshell," according to the authors. "The young may get the upper hand and decide the very old have a bioethical duty to die,’" they note. And worst of all (depending on your age and/or point of view), "They may refuse to pay for every conceivable medical procedure that might be of benefit for the now-geezer boomers."
Nonetheless, Styring and Jonas do not view the future in entirely bleak terms. "The baby boomers will cause a serious rethinking of what most of us have come to think of as the natural state of affairs. Employment-based insurance will shrink and the tax exclusion, which drives it, will be repealed.
Medical Savings Accounts will be prevalent. Seniors’ entitlements will be reneged upon. The possibility of war among the baby boomers and baby busters is quite real, although we think that will not happen. And the Busters will wind up with a raw deal, but not one with which they cannot live."
The Princeton, NJ-based Robert Wood Johnson Foundation (http://www.rwjf.org), the nation’s largest philanthropy devoted exclusively to health and health care, funded the research and production of Health Care 2020. The Hudson Foundation (http://www.hudson.org) is a public policy research organization that develops solutions and forecasts trends for governments and businesses. Health Care 2020 is available for $16.95 per copy, with a 25% discount for orders of 25 or more. To order, call (800) HUDSON-0, or (317) 545-1000.
Assessing hospital patients for nutritional deficiencies not only helps reduce the incidence of post-operative complications and re-infection, but can also cut total hospitalization costs, according to data presented at the American Association for Clinical Chemistry’s 1999 annual meeting.
The nutritional assessment process includes taking a complete medical and dietary history from patients, as well as clinical testing of pre-albumin and albumin levels to detect evidence of protein-calorie malnutrition (PCM). Characterized by depletion of muscle, visceral protein stores, and body fat, PCM’s clinical manifestations include increased morbidity and mortality, impaired wound healing, and compromised immune response.
Detecting and addressing PCM early in the hospitalization process (optimally at admission) "increases the chances of a positive outcome for patients, as well as reducing overall length of stay," according to Elia Mears, director of Laboratory Services at the Leonard J. Chabert Medical Center in Houma, LA. Data presented by Mears shows that the nutritional assessment program instituted at the center in 1995 reduced the facility’s readmission rate by close to 4% during its first year of operation, at the same time generating some $600,000 in savings attributed to reductions in length of stay.
For additional information, contact Mears at (504) 873-1339, or via e-mail at MearsEli@CMC. LHCA.State.LA.US.