Putting a little ‘heart’ into public investments in health really can pay off

conditionslowdowns-300x215Take heart, Americans. Taking care of ourselves makes a difference, making us healthier — and saving us money.  New research supports policies for spending on the wellness of the elderly, improving heart care, and how smart interventions can reduce rising overall health costs.

This evidence-based approach to figuring the government’s optimal role in individuals’ health also may provide a rebuke of sorts to the way that partisans are imposing draconian new rules to curtail medical assistance for the working poor, poor, aged, and chronically ill Americans.

The rare good news about the nation’s health care costs traces to investigators’ efforts to determine why, in contrast to expectations that spending would leap, Americans’ $3.5 trillion annual medical expenditures increased only slightly. They drilled down, focusing on an area where the “sharpest slowdown” occurred in their research period, 1999-2012: Medicare, a federal program that now enrolls roughly 15 percent of the U.S. population, with beneficiaries 65 and older.

As the Washington Post reported:

[A]bout three-quarters of the health spending slowdown nationwide was due to slow-as-an-(almost)-trickle growth in spending on the elderly. From 1992 to 2004, per-capita spending among Medicare beneficiaries grew by 3.8 percent each year, adjusted for economy-wide inflation; since 2005, the rate has been a mere 1.1 percent, according to a new Health Affairs study. In plain English, that means total spending per elderly person hasn’t fallen, per se, but we’re spending thousands of dollars less today than was projected to be the case back in the early 2000s.

Some experts attributed this lessening on the bad economy, notably the Great Recession. Times were so tough that patients, especially the elderly, cut back on all expenses, including health spending. But Medicare expenditures, backed by Uncle Sam’s treasury, wouldn’t be so influenced by economic circumstance. Instead, researchers looked at health spending by category. And they had their “aha!” finding. Preventive care had slashed spending on heart diseases and their treatment, becoming a leading factor in lessening Medicare costs. As the Washington Post reported:

[T]he researchers calculated that more than half of the elderly spending slowdown was because of slower spending on cardiovascular diseases and conditions. In dollar terms, this means the slowdown in cardiovascular spending growth effectively saved the Medicare program about $34 billion in 2012 (the most recent year of data available).

Now, it’s disputed among health experts as to the extent that preventive care costs, or that, ultimately, it saves significant sums. But the researchers reported, as the newspaper noted, that, “greater use of statins, anti-hypertensives, diabetes medications and aspirin has helped prevent lots of expensive health events and contributed to outright declines in hospital admissions for heart disease and stroke.”

Think about the benefits of Medicare as a public health investment: Shouldn’t we be pleased that many more seniors live better and longer — that they’re not staggered as much by stroke, heart attacks, and otherwise debilitated by cardiovascular diseases?

In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, effective, and excellent medical care, particularly as costs skyrocket for treatments and prescription drugs — even as their complexity and uncertainty also soar. We all can do our part to safeguard our health by eating sensibly, exercising, avoiding alcohol and substance abuse, and not smoking. This doesn’t need to be drudgery and we can make it part of our 2019 resolve. Meantime, social safety net programs, which taxpayers invest in and support, have become a health boon for seniors, especially as the nation goes grayer by instant.

And while Medicare provides Americans 65 and older with greater health and financial security, Medicaid gives key assistance to the working poor and the poor, including the old, young, and those with chronic physical and mental illness. Political partisans dislike both programs and have made Medicaid a slash-and-burn target. Lawmakers in Washington, D.C., and state capitals have moved to add new, harsh work and reporting requirements for beneficiaries to discourage them off Medicaid.

The Los Angeles Times, however, has examined the actions of state and Trump Administration officials, finding they have failed to follow federal rules governing Medicaid “experiments,” policy changes designed to improve the program. The rules require that any program changes must “estimate effects on coverage before the initiative starts, and then independently evaluate the impact of the programs after they begin to assure [that] they are achieving their goals.”

This has not occurred, even though states have started to put in place work requirements, and this has led to the ejection of thousands of Medicaid participants already, the newspaper reported.

Sara Rosenbaum, a Medicaid law expert at George Washington University’s Milken Institute School of Public Health, explained why program changes require documentation, evidence, and research, in advance: “States are drawing down hundreds of millions of dollars in taxpayer money. If they want to experiment, we want to know whether what they are doing is working, what we are gaining, what we might be losing and what the effects are on patients.”

The newspaper noted that other federal authorities with oversight on the Centers for Medicare and Medicaid Services (CMS) may question, delay, or reverse the agency’s approval for experiments, changes, or “reforms” in Medicaid by states. CMS reports to an independent congressional advisory commission, as well as to Congress itself. It also can be subject to scrutiny by the nonpartisan Congressional Budget Office.

Wouldn’t it be best for Medicaid to operate using not belief but in a research- and evidence-based way? Maybe the program, like Medicare, can find that improving participants’ health also has the fiscal impacts that critics claim they so desire?

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