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Health Care

Existing economies for chronic care of the elderly are unsustainable. Fix them.

After legislation in June added prescription drug benefits to Medicare (the U.S. program that provides health care for the elderly), many said that American health care was in crisis. Conservatives worried that the new legislation did not encourage the participation of private insurers; liberals regretted the absence of price regulation of pharmaceuticals. But it is nothing new to say that the financing of health care in the United States is in crisis. As health care�s percentage of the gross domestic product has grown (some experts estimate it could climb from 13% presently to 16% by 2010), economists and policy makers have fretted that the proportion of money devoted to health is a terrible drag upon economic growth and investment. This is not a crisis: one can imagine a functioning economy, albeit a very different one from today�s, in which the medical-industrial complex constitutes a much larger fraction of the GDP. The problem (as argued in �Aging Gracelessly,� page 32 of the Journal, Issue 2) is that the economic structure of the U.S. health care system is not sustainable, based as it is upon a confusing arrangement of private and public insurance schemes.

Medicine in developed economies, once concerned with heroic interventions for acute conditions, is now overwhelmingly concerned with caring for an elderly population with chronic illnesses. Around 100 million Americans suffer from chronic conditions; at least 40 million have more than one. This country spends about $470 billion on medical care for its aging population, an amount that will double by 2050. More than 66% of hospital admissions are now for treatment of chronic conditions, as are 88% of filled prescriptions and about 70% of physician visits. Nearly two-thirds of Medicare dollars go toward caring for people with five or more chronic conditions. Insurance economics, which, by its nature, prices events that might happen and whose severity or timing are unknown, cannot pay for health care when sickness is inevitable, chronic, and indefinite.

The Acumen Journal of Life Sciences proposes that health care economics change to a more open system based on investment by individuals, companies, and governments, a system in which risks can be evaluated and pooled more rationally and preventive medicine is properly valued. The nature of that future system can be debated by men and women of good conscience, but the ill health of the current system can no longer be ignored.



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