On June 30, the Senate Special Committee on Aging held a hearing entitled, “Saving Dollars, Saving Lives: The Importance of Prevention in Curing Medicare.”
Ranking Member Herb Kohl (D-WI) chaired the hearing, which focused on the high cost of treating patients with chronic conditions, such as heart disease, diabetes, and osteoporosis. He explained that a number of these conditions could be prevented if seniors exercised more, ate healthier foods, and quit smoking. “Seniors need to understand that it is never too late to benefit from a healthy lifestyle,” he stated.
Citing statistics provided by the Congressional Budget Office (CBO), Chair Gordon Smith (R-OR) said that “only 10 million of the 40 million Medicare beneficiaries account for 90 percent of the program’s costs. Further, three-quarters of these 10 million high-cost beneficiaries suffer from multiple chronic diseases…[that] require extensive care and often serve as the catalyst for many other conditions and ailments. Many of these chronic conditions are preventable through a regimen of proper nutrition and exercise. Additionally, the cost of treating these conditions can be significantly reduced by the implementation of chronic disease management programs.”
Douglas Holtz-Eakin presented the CBO’s report on high-cost Medicare beneficiaries. He explained that in order to contain health care costs, a number of private health plans have begun to offer disease management as a “model of care” for chronically ill patients: “Disease management programs vary widely in the specific techniques and tools they use, but they share some common components that are designed to address several perceived shortcomings of current medical practice. One component is to educate patients about their disease and how they can better manage it. The goal is to encourage patients to use medication properly, to understand and monitor their symptoms more effectively, and possibly to change their behavior. A second component is to actively monitor patients’ clinical symptoms and treatment plans, following evidence-based guidelines. A third component is to coordinate care among providers, including physicians, hospitals, laboratories, and pharmacies.” The report concluded, “Initial results from disease management programs and other efforts indicate the difficulty of reducing the use of care. In certain cases, the health conditions underlying high spending may not be amenable to effective interventions. Moreover, although interventions may improve health outcomes for high-cost beneficiaries, they may lead to increases in the use of medical care. It is important to note that improving the care received by high-cost beneficiaries in itself may be a worthwhile objective, even if it fails to reduce costs.”
Dr. William Evans, a professor of geriatric medicine, nutrition, and physiology in Little Rock, Arkansas, said that one of the most common features of aging is a substantial loss of muscle, known as sarcopenia: “Sarcopenia results in weakness, frailty, reduced calorie needs, reduced functional capacity and a greatly increased risk of disability in older people. The prevalence of sarcopenia among men and women above the age of 65 is greater than 20%. The estimated direct healthcare cost attributable to sarcopenia in the United States in 2000 was $18.5 billion ($10.8 billion in men, $7.7 billion in women), which represented about 1.5% of total healthcare expenditures for that year.” Dr. Evans explained that with exercise seniors could regain more than 15 years of loss in their aerobic capacity or fitness, stating, “Our initial research was in healthy, but inactive, older men. In 10 weeks, we demonstrated that resistance exercise training tripled the strength of these men and substantially increased the size of their muscles. We were also able to demonstrate that one year of strength training (two days per week) stopped the loss of bone and increased bone density of the spine in a group of older, post-menopausal women. This effect was as great as any seen with anti-osteoporosis drugs that are currently in use. However powerful the effects on bone, the exercise intervention affected other factors that are known to be associated with a risk of falling. The women in this study got stronger, increased their muscle mass, improved their balance, and showed an increase in levels of physical activity.”
Dr. Steven Woolf, a professor of family medicine, epidemiology, and community health at Virginia Commonwealth University (VCU), addressed the health disparities that exist among senior populations. According to a study published in the American Journal of Public Health, “Native Americans age 55 and older are 1.5-2 times more likely than whites of the same age to be obese, to be inactive, and to smoke cigarettes. Similar disparities in unfavorable risk factors exist among African American, Hispanic, and other seniors in minority groups.” He also noted that a study done at VCU found that “for every life saved by medical advances, five would be saved by correcting the disparity in death rates between African Americans and whites.” Dr. Woolf stated, “Compared to gene mapping and stem cell research, fixing the causes of disparities is less glamorous and less likely to make the evening news, but it is far more likely to save lives. Congress should support research to understand and correct disparities in the health status and healthcare of disadvantaged persons and minorities.” He also encouraged Congress to promote better public education about prevention and healthy lifestyles, support smoking cessation programs, and provide more funding for the Agency for Healthcare Research and Quality (AHRQ). “Congress should strongly consider doubling the budget of AHRQ spending two pennies for every [National Institutes of Health] NIH dollar given the gravity of today’s problems with healthcare and the importance of the issue with Americans, including seniors…An expanded investment in AHRQ would send a public message that it is important to Congress not only to develop cutting-edge treatments but also to ensure that Americans receive them,” he stated.
