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Aging population looms over health care costs

By Terry Rindfleisch

 Lacrossetribune.com , April 16, 2003

 Addressing rising health-care costs takes on a new urgency with the aging of the baby boomers. By the year 2020, the number of Americans 85 and older will more than double to 6.4 million. The number of people 65 to 84 will almost double to 47.1 million.

Baby boomers entering their senior years will increase costs at an alarming rate because the elderly traditionally use a larger share of the health-care dollar. And if we can't control rising health-care costs now, how are we going to do it in the future?

"Federal and state governments are not dealing with the issue," said Dr. Jeffrey Thompson, Gundersen Lutheran Medical Center chief executive officer.

Inadequate Medicare and Medicaid reimbursement to health-care providers only will get worse without good solutions and could put some providers out of the business in the future, Thompson said.

Medicare and Medicaid programs are in financial trouble, and the cost of long-term care and nursing home care is increasing, he said.

"We survive because we share the Medicare and Medicaid patients with Franciscan Skemp," Thompson said. "Our plan for the future is to be organized and efficient and try to get the best reimbursement.

"The path to thriving for providers is squeezing out the best efficiencies while maintaining the best quality," he said. "A lot of people are trying to fix the problem. I can't fix Washington. I can only control what I can control."

 

Dr. Glenn Forbes, Franciscan Skemp Healthcare chief executive officer, said health care providers need to be driven by quality and efficiency, the public needs to become better educated to make better health choices, and government needs to set priorities but can't under-fund programs.

"The long-term solution requires government, hospitals, doctors, the public, insurance companies and all groups working close together," Forbes said.

"The re-engineering of medical care is a 30-year venture and won't be solved in five to 10 years," he said.

Both La Crosse medical centers have implemented cost efficiency and quality measures in the last few years and are looking to do more. Gundersen Lutheran has joined a statewide collaborative of health care providers, employers and union organizations to report measures of health care quality.

Forbes said patients will pay more for their care in the future, and they will have to accept more responsibility for their own health. He said he expects people will have to make choices and will receive slightly less health care in the future, but will be offered some catastrophic care.

Thompson said rationing of health care is a possible in the future, "but my hope is it doesn't get to that point."

A recent survey conducted by the University of Wisconsin-La Crosse political science/public administration department for the La Crosse Tribune and WXOW-TV 19 showed 31 percent thought government could best control health care costs, while 28 percent said health care providers could do a better job.

Respondents were split on whether the American health care system should be a private or government enterprise. About 47 percent favored a private system and 43 percent preferred a national system operated by the federal government.

Many more people (43 percent) preferred an employer-sponsored system over a government-subsidized system (26 percent) to pay for health care .

"We're going to have to find some politicians who will listen to their constituents, so we can find some solutions to the health care crisis," said Terry Hicks, president of the local AFL-CIO who favors a national health insurance program.

Rick Mickschl, president of Trane Co. machinists Lodge 21, said business, labor and health care providers and payers will continue to look for ways to work together. "We can't solve this alone," Mickschl said.

Jorge Gomez, Wisconsin's insurance commissioner, said future challenges include coming to grips with health care costs and how to expand health insurance coverage for employees who can't get coverage. Gomez said Gov. Jim Doyle has suggested small employer insurance pools to help small employers offer affordable insurance to their employees.

"There are solutions to rising health-care costs, but they're not all inviting, and they're will be winners and losers," he said.

Third District Congressman Ron Kind, a leader of the Rural Health Care Coalition, said the Bush administration won't be focusing on health care with the war in Iraq and a slow economy.

"It's going to take sustained focus and leadership, and maybe the focus will be come in the next presidential race," Kind said.

"Health care is a political ping-pong ball, and it's going to take a political coalition of business, labor, health care providers and consumers that continues to grow and adding pressure on policy-makers to get off the dime," he said.

Kind also is emphasizing that people need to discuss end-of-life decisions such as living wills and advance directives with their loved ones. Health-care costs in the last six of weeks of life are significant, he said.

"We all need a better understanding of our loved one's expectations at the end-of-life," Kind said. "This is not about government intervention but about individual empowerment. We need to think this through. The implications could be costly."

Steve Kunes, executive director of Franciscan Skemp's Health Tradition HMO, said the health-care crisis is a perfect storm.

"Many things are brewing," Kunes said. "We all have expectations - people wanting the latest technology, treatment and cure and all the new drugs - and then trying to figure out who is going to pay for them.

"It's a swirling storm that could hit us anytime," he said. "There are no easy answers."


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