A looming health care crisis for seniors?

Crisis talk continues to dominate public debates about health care in America. This week, a front page story in USA Today warned readers that “a health care crisis looms for seniors” as 8 in 10 Americans over the age of 65 reported at least one chronic condition. The result, argues reporter Michelle Healy, is “an emerging health care crisis.” Alas, this notion misdiagnoses the underlying condition facing our health care system. While seniors now live longer, and as a result, cope with more chronic health problems as they age, this is hardly a crisis. As the story notes, the demographic shift of an aging America, coupled with recent rises in obesity, diabetes, arthritis, and other conditions are chronic conditions, not acute ones. This misdiagnosis is not simply a question of word choice. The concept of a “senior health crisis” is a misnomer that suggests that things have taken a dramatic turn for the worse. Implicit in such cries of crisis is the notion that swift action can reverse, or “cure” the crisis.

Ironically, Healy’s diagnosis of a crisis is based on the existence of several interconnected, chronic conditions (i.e., obesity, diabetes, etc) that are often preventable, evolve slowly–if not imperceptibly–over time, and quite common. To ensure that millions of older Americans don’t experience what David Cutler describes in Your Money or Your Life as “the failure of success” (in which we live longer, but feel worse), policymakers need to provide incentives for seniors to embrace healthier lifestyles. Access to well-coordinated primary care is also essential to manage these ongoing health concerns. Both are long-term challenges, particularly as we approach the rollout of the Affordable Care Act in 2014. The ACA emphasizes the importance of changing health behaviors, and also brings millions of previously uninsured, or under-insured Americans into the health insurance marketplace. A key challenge in the coming years is to ensure that all Americans–young and old–have access to regular primary care; in the short run, the ACA is likely to exacerbate the existing shortage of primary care providers who play a key role in counseling and supporting patients to modify their health behaviors.

Like all chronic conditions, changing health behaviors and persuading more doctors, nurse practitioners, and physician assistants to embrace primary care, despite powerful incentives to specialize, requires the implementation of “disease management” techniques to adjusts incentives for doctors and patients.


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