Healthcare costs hit older Americans

BMJ 2002; 324 doi: (Published 30 March 2002) Cite this as: BMJ 2002;324:756
  1. Fred Charatan
  1. Florida

    Elderly Americans are being hit hardest by rising healthcare costs, and doctors are beginning to refuse Medicare patients because the payments from the government do not cover the costs, the doctors say.

    In the last two years US spending on health care rose by more than 8% each year (BMJ 2001;322:692). Medicare covers either fee-for-service care with a private doctor or membership in a health maintenance organisation for people aged over 65. But many older Americans were dropped when health maintenance organisations pulled out of Medicare (BMJ 2001;323:772).

    The American Association of Health Plans said, “With healthcare inflation running at 12% and Medicare reimbursement capped at 2% you have a mathematical formula that does not work.”

    Those organisations still serving elderly Americans are now struggling to clamp down on expenses by raising monthly premiums, deductibles, and especially co-payments. The goal is to shift more of the costs of health insurance to the consumer.

    Organisations for elderly Americans lobbied hard for a benefit to cover prescription drugs. The Bush administration offered a drug discount card instead, as a way to help limit Medicare expenditures.

    The National Committee to Preserve Social Security and Medicare, which helped defeat the administration's drug discount plan in Congress, said, “The administration's discount prescription drug card is no substitute for a universal and voluntary prescription drug benefit.”

    The American Association of Retired Persons blamed drug manufacturers for driving up the cost of prescription drugs through direct advertisements and promotions to consumers. In 2000 the drug industry spent almost $2.5bn (£1.75bn; €2.8bn) on advertisements in the mass media and also worked to keep cheaper generic drugs out of the marketplace. The rise in cost of prescription drugs has forced many elderly people to make painful choices between food and medicine.

    Now many doctors are refusing to take new Medicare patients. They say the federal government pays too little to cover the costs of caring for their elderly patients. Medicare cut payments to doctors by 5.4% this year. Under current law the fees paid for each medical service will be reduced by 17% by 2005.

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