Today is my birthday: I am 67. That means I am an old fart with all the rights and privileges bestowed.
I get a pass for untrimmed nose hair, occasional memory lapses and frequent illusion to the good ole’ days. Demographers call me a boomer; financial advisors a retiree; retailers a ‘classic’ purchaser and health providers a patient. I qualify for discounts on everything from flights to movie tickets and my mailbox is full of offers for time-shares, long-term care insurance, laxatives and retirement planning.
I recently had the unique experience of enrolling in Medicare Part B (physician services et al) and D (prescription drug benefit plan). I bought a supplemental policy rounding out my coverage to the tune of more than $600 monthly. Just yesterday, I received my 2017 Part D coverage explanation: a 156 page magnus opum that’s unlikely to be read—it’s part of the right of entry into senior-hood.
I still work every day and workout at least 4 times weekly. I have a titanium knee and use a statin to manage my heart disease. I feel healthy. I walk the golf course carrying my own bag and I don’t reminisce about I Love Lucy and Lawrence Welk but no less a card-carrying, full blooded senior. Health and healthiness are always on my mind. It’s part of the journey, but I must admit to a sense of resentment about the way health industry insiders think about me and my peers.
The reality is this: healthiness and aging go hand in glove, but being older is not about being old. And healthiness is about more than getting a diagnosis or prescription, filling beds and waiting to die.
Pundits and health policy wonks are quick to point to the obvious: the 54 million-strong Medicare population is growing exponentially as 10,000 Baby Boomers age-into the program daily. That’s one in six in our population, and one in three by 2065. But the health system needs to step back and revisit its false assumptions about me and my peers:
1-We’re not stupid. Providers think we are unable to understand our condition and participate in treatment decision-making. They think we are not inclined to study on our own and dependent on their recommendations alone. They believe we worship at the altar of M-Deity and hold on every word they utter. They think we maintain our physician relationships jealously believing we’d change churches or banks before we’d change our docs. And they think we recognize the huge gap between their expertise and that of nurses, pharmacists and non-traditional providers whose clinical counsel they consider inferior.
Facts: Seniors pay attention to the health system like no other generation. We pay attention to stories about medical error that are responsible for more than 251,000 deaths annually (BMJ). We know physicians don’t always get it right (6-17% diagnostic error per Institute of Medicine). We know a hospital can be an unsafe place (1 in 3 hospital admissions results in an adverse event per Health Affairs). We trust doctors, but we trust nurses and pharmacists equally and listen to what they say. And we know death from lifestyle-complicated factors—the food we eat, the anxiety we experience, the places where we live-- is as important as the blood tests and physical exams we undergo. We’re realistic: we know end of life heroics that keep us alive for a few extra days drain the inheritance we’d prefer to leave our kids (JAMA Internal Medicine) and prefer a painless but natural end. We’re not stupid; we’re watching, we’re learning and we have lots of living to prepare ahead!
2-We’re not technophobes. Providers think we watch the three major networks for our news and think Facebook can be bought in Barnes and Noble. They believe we’re online rarely and immune to social media. And they believe our technology prowess is limited to our TV remotes and e-mail still a novelty and they don’t think report cards about their performance garner our attention. Think again.
Facts: Seniors use technology for banking, shopping and getting their news. The majority of us want access to our own medical record and believe e-scheduling and accessing routine test results should be standard operating procedure (Accenture). Three in four of us want to communicate with our physicians between visits by e-mail but we know they pushback due to cost or inconvenience. And the most of us think our prescription refills could be expedited by e-prescribing, if our docs were willing. We are online and onboard; it’s our providers who are retarding techno-connectivity.
3-We’re not satisfied. Providers think their time is more valuable than ours. They think waiting rooms are for waiting, especially for seniors and those without insurance. They think healthcare is about specialties and technologies and pills that can fix anything. And they believe seniors are happy about how the system performs, especially those with serious medical conditions.
Facts: Gallup polls show deep concern by seniors about accessibility and affordability. More than half of us think the quality of care in our system is eroding. Most of us think our physicians are prone to be condescending and we’re sensitive to their resentment about what Medicare pays. We resent being put on endless hold by customer service call lines that afford little service and none of us understands what things cost or how our charges are calculated.
Recently, the healthiness of the two major party candidates has become an issue because they’re seniors: Donald Trump will be 70 if he wins the White House in 57 days; Hillary Clinton will be 68. The complete health records for neither candidate have been released: a letter from Trump’s primary care clinician (a gastroenterologist) affirms his healthiness and speculation about Secretary Clinton’s thrombophlebitis (venous blood clots) in the aftermath of her 2012 fall and concussion are points of curiosity to pundits and partisans. She’s reported to be a blood thinner (Coumadin) and perhaps other medications and yesterday’s coverage of the 9/11 remembrance in New York was interrupted by news of the Democratic nominee’s early exit due to pneumonia. An individual’s health status is deeply personal and private, unless they’re older and in a position of leadership.
It’s a political tradition. Ronald Reagan was elected at the young age of 69, FDR served 12 years in the White House many in a wheelchair, JFKs struggled with Addison’s Disease and in 2008, war hero John McCain’s cancer was a prominent issue in the 71-one-year old’s campaign against a youthful Barack Obama.
In ancient Greece and Rome and modern China, Korea, India and other world economies, seniors are held in esteem. In healthcare, we’re not so inclined. We dismiss them as dependents and their economic impact as dilutive. And if they’re elected officials, we pay special attention.
Seniors are not stupid, technophobic nor satisfied with the health system. We know the difference between a system that works and a collection of independent sectors that fend for themselves. We know we are the system’s heaviest users and its least respected.
Other industries seem more serious about delivering service and optimizing value for their seniors; healthcare can learn a few lessons. We care about healthcare and see room for improvement.
P.S. Dartmouth’s announcement its Accountable Care Organization was suspending operations due to mounting losses should be no surprise. The data showing the modest success of ACOs—only 28% qualified for shared savings after two years—underscore fundamental flaws in the ACO model and the reality that savings are more likely in inefficient, high utilization, high-cost markets. In discussions with health systems in 2012 as the ACO movement was gaining momentum, I advised against participation unless a large medical group with prior experience and infrastructure necessary to manage risk and a market where costs and utilization were inexplicably high (usually the result of supply-induced demand). Expect changes from CMS to the Medicare Shared Savings Program aka Accountable Care Organizations. They’re important to CMS but there are flaws.