This may be a little wonky for so early in the morning, but what the hell, this is why you guys love me. We all know that Medicare threatens to consume the federal budget for an afternoon snack if allowed to grow unchecked for the next couple of decades. What's a bit more complicated is why. Kenneth Thorpe and David Howard, writing over at Health Affairs, have an answer that may or may not be illuminating. According to them, if you run the data, basically all the growth seen in Medicare since 1987 came in patients being treated for five or more conditions. That's because, in 1987, 31 percent of seniors were under medical management for 5+ health issues, accounting for just over half of spending. In 2002, it was 50.2 percent, and they accounted for two-thirds of spending.
What isn't entirely clear is the causality. Are more seniors under treatment for more conditions because we've better diagnostics? Because we've become more aggressive diagnosers? Because we're getting fatter? Because we're living to be older? The paper doesn't say, and it's not clear anyone knows. Nevertheless, where 1987 saw 2.6 percent of seniors under treatment for high cholesterol (hyperlipidemia), 2002 saw a tenfold increase to 22.6 percent. Hypertension went from 35 percent to 45, while diabetes shot from 11.4 percent to 17.5 percent. Is it any wonder we're spending more money?
We do, happily, seem to be getting something for the expenditures. In 1987, 33 percent of seniors with five or more conditions reported being in excellent or good health. In 2002, that number was 60 percent. And we know from clinical data that the elderly are less disabled than they used to be -- leading to lower per-year spending, and higher quality of life. So that's encouraging, but it doesn't say much about the correct policy path going forward.
As for what needs to be done, that's the 64 trillion dollar question. You guys have heard me talk about the 80/20 rule before -- a stunningly small number of patients account for an overwhelming majority of health spending. At least among the young. If you take 22-year-olds, very few of us spend a lot on health care. Thankfully, I'm being treated for precisely no problems right now. But a couple of us get into car accidents, or have genetic diseases, or otherwise spend a ton. That top five percent makes up almost all spending among my cohort. As we get older though, that top five percent receiving intensive treatment becomes seven, then twelve, then twenty. More and more diseases develop, and where diabetes and heart disease were once rare, now they're common. That's the problem among the elderly -- the norm is multiple, costly conditions. It's not that anyone is spending particularly excessively (though some certainly are), but that everyone is spending.
