Boomer Health Care Dilemma

How Will Baby Boomers Cope As First Wave Approaches Retirement

(WebMD)  Are rising health care costs among the elderly really a bad thing? Does where you live determine the type of medical care you receive after you retire? Why do aging women get sicker while aging men die faster?

Those are just some of the questions experts are trying to answer as the first wave of Baby Boomers approaches retirement age in 2011. Rather than rely on their families to care for them in retirement, researchers say Baby Boomers will face a new set of challenges in order to stay healthy longer.

"They have fewer children to care for them, and more of their children are divorced and living at great distances," says Richard Suzman, PhD, associate director of the behavioral and social research program at the National Institute on Aging (NIA). "People will have to maintain their health for longer periods of their life in order to be able to function effectively."

Suzman moderated a briefing in New York City this week sponsored by the NIA on the health and economic challenges of an aging population.

Researchers say that major changes in the way people make decisions about their personal health and financial future as well as public policy will make a critical difference in their health and well-being later in life.

Rising Health Care Costs: A Good Thing?

One of the most common complaints about the health care system is the rising cost of medical care, especially among older adults.

But health economist David Culter, PhD, of Harvard University in Boston, says the real question is whether we're getting a better value for the money we spend on health care. He says current health technologies, on average, return $4 in approximate life value for every medical dollar spent.

"Too often we think just about the cost and not what it's worth to us," says Culter, who spoke at the briefing.

In 1950, Cutler says the cost of treating a heart attack was virtually nothing because the only available treatment was bed rest for six months, and as a result the outlook for heart attack survivors was bleak. Today, the cost of treating a heart attack with drugs to restore blood flow and surgery to repair clogged arteries is nearly $30,000 for a 45-year-old.

As a result of those expensive, but effective treatments, the proportion of people who die within three months of a heart attack has fallen by three-fourths since the 1950s.

"The single biggest thing that has happened over time in terms of mortality is that cardiovascular deaths have fallen by about two-thirds since 1950. [This was] right at a time when people were saying ‘this is the biggest killer and we can't do anything about it' and it turns out we can do quite a bit," says Cutler.

Although increased health care spending has bought us better health and longer life, he says wasteful health care spending is one of the biggest issues now and will continue in the future.

The challenge is figuring out how to get the best value out of the money spent on health care. A possible solution, Cutler says, is to link health care payment to performance and pay health care providers more for doing a better job.

"Why do we spend more? Because we get more stuff," says Cutler. "When you pay for doing stuff, you get a lot of stuff. But if you pay for effectiveness, you pay for less stuff."

Regional Differences in Health Care Value

Researchers say where you retire may also determine how much of your retirement fund goes towards health care spending. But spending more doesn't necessarily mean you'll get more bang for your buck.

"Medical expenditures are higher in Miami than in any other major American city, yet its residents don't live any longer or healthier than other Americans," says Jonathan Skinner, PhD, professor of economics at Dartmouth College in Hanover, N.H.

In fact, he says research shows that there's a negative association between how much a state spends on health care and the quality of heath care its residents receive.

"Places that spend more money get lower quality care than those that spend less," says Skinner.

Skinner says living in an area that spends more money on health care also doesn't necessarily increase the chances of getting a high-tech treatment. Research shows that Medicare patients in Miami are less likely to get hip or knee replacements or heart surgery than in Minneapolis, which spends about half as much per capita on Medicare expenses as Miami.

Instead of high-tech and high-cost treatments, he says the factors associated with better value in regional health care spending appear to be greater use of low-cost effective treatments, such as use of aspirin and beta-blockers in the treatment of heart disease.

Women Get Sick, Men Die

Another issue facing an aging America is gender differences in health. Women report significantly worse health from adolescence through middle age, but at every age men are more likely to die.

Several explanations have been offered to explain this gender difference. Some say women may be "whiners" while men are "stoic" about their health. Or women suffer from medical conditions such as arthritis and back pain that make them sick, but men suffer from ones such as lung cancer and heart disease that kill them.

But new research shows that another factor may be to blame: tobacco.

Anne Case, PhD, professor of economics and public affairs at Princeton University, says her research shows that men and women actually report about the same overall health when they suffer from the same chronic conditions.

However, when men and women have the same condition, men usually have a more severe form and spend more time in the hospital.

"For heart disease, lung cancer, and emphysema, men are more likely to die than women who report same condition," says Case.

Case says all of those disorders are related to smoking, and men are more likely to develop these conditions at older ages and they also have more cumulative years of smoking than women.

But she says the bad news for women is they didn't heed Surgeon General's 1964 warning about the health hazards of smoking as fast as men, and the smoking-related differences in death rates between men and women are now narrowing as a result. Men's smoking rates have declined steadily since the 1960s, but smoking rates among women increased after the warning and only began to decline in the 1980s.

SOURCES: Richard Suzman, PhD, associate director, behavioral and social research program, National Institute on Aging. David Cutler, PhD, professor, economics, Harvard University, Boston. Anne Case, PhD, professor, economics and public affairs, Princeton University, Princeton, N.J. Jonathan Skinner, PhD, professor of economics and community and family medicine, Dartmouth Medical School, Hanover, N.H. Dana Goldman, PhD, senior economist; and director, health economics, RAND Corporation.