Is Prevention Key to PreventingIs Prevention Key to Preventingan Aging Tsunami?an Aging Tsunami?

Remarks of William F. BensonRemarks of William F. BensonBoard of Advisors MeetingBoard of Advisors Meeting

Center on Global Aging/NCSSSCenter on Global Aging/NCSSSJune 12, 2009June 12, 2009

What I Will Touch Upon What I Will Touch Upon

• Demographics of an Aging SocietyDemographics of an Aging Society• Health Care ExpendituresHealth Care Expenditures

• MedicareMedicare• Long-Term CareLong-Term Care

• Political/Policy ImplicationsPolitical/Policy Implications• PreventionPrevention

• Health Care ReformHealth Care Reform

““The Future Ain’t What The Future Ain’t What It Used to Be” (Y. Berra)It Used to Be” (Y. Berra)

Percentage of Population Over Age 65Percentage of Population Over Age 65

Source: U.S. Census BureauSource: U.S. Census Bureau

20002000 20152015

20252025

5%-9.9% 10%-14.9%5%-9.9% 10%-14.9% 15%-19.9% 20-30% 15%-19.9% 20-30%

Source: From Baby Boom to Elder Boom: Providing Health Care for an Aging PopulationSource: From Baby Boom to Elder Boom: Providing Health Care for an Aging Population Copyright 1996, Watson Wyatt Worldwide.Copyright 1996, Watson Wyatt Worldwide.

00

55

1010

1155

2020

2525

19301930 19501950 19701970 19901990 20102010 20302030 20502050

YearYear

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An Aging PopulationAn Aging PopulationPercentage of U.S. Population over Age Percentage of U.S. Population over Age

6565

Baby BoomersBaby Boomers

A Baby Boomer turns 50 every 7.5 A Baby Boomer turns 50 every 7.5 seconds.seconds.

In 2006, the first Baby Boomers turned 60.In 2006, the first Baby Boomers turned 60.

In 2011 the first Baby Boomer will turn 65.In 2011 the first Baby Boomer will turn 65.

People turning 50 today have half of their People turning 50 today have half of their adult lives ahead of them. adult lives ahead of them.

Gro Harlem Brundtland, Director-GeneralGro Harlem Brundtland, Director-GeneralWorld Health OrganizationWorld Health Organization19991999

Gro Harlem Brundtland, Director-GeneralGro Harlem Brundtland, Director-GeneralWorld Health OrganizationWorld Health Organization19991999

““Population ageing is first and foremost Population ageing is first and foremost a a success story for public health policiessuccess story for public health policies as as well as social and economic development.”well as social and economic development.”

Demographic Impact on Aging PolicyDemographic Impact on Aging Policy

• ““In general, the aging of the baby boom In general, the aging of the baby boom generation will lead to a sharp growth in generation will lead to a sharp growth in federal entitlement spending that, absent federal entitlement spending that, absent meaningful reforms, will represent an meaningful reforms, will represent an unsustainable burden on future unsustainable burden on future generations.” (GAO-05-564T)generations.” (GAO-05-564T)

Demographic Impact on Aging PolicyDemographic Impact on Aging Policy

““The population’s aging will also cause a The population’s aging will also cause a decline in the share of the population who decline in the share of the population who are of working age – and who pay the bulk are of working age – and who pay the bulk of the taxes that support public programs for of the taxes that support public programs for the elderly.” the elderly.”

Source: CBO (Source: CBO (Financing Long-Term Care for the ElderlyFinancing Long-Term Care for the Elderly, , A CBO Paper, April 2004)A CBO Paper, April 2004)

The Atlanta Journal-Constitution Tuesday, May 15, 2001The Atlanta Journal-Constitution Tuesday, May 15, 2001

““Retiree benefits grow into Retiree benefits grow into 'monster' 'monster' Taxpayer burden: Taxpayer burden:

$510,678 a family”$510,678 a family”

USA TodayUSA Today

May 25, 2006May 25, 2006

Health Care Expenditures Health Care Expenditures 20072007

Total Expenditures (2007) -- $2.3 trillion

Private – 53% Public -- $47%

By 2016 Public expenditures will be 50.4%

Medicare -- $442 billion

Medicaid -- $349 billion

Source: The Washington Post – “In Search of Health-Care Reform June 9, 2009

Medicare & Social Security Board Medicare & Social Security Board of Trustees Report – March 26, of Trustees Report – March 26,

20082008

Medicare's Hospital Trust Fund Will Be Insolvent Medicare's Hospital Trust Fund Will Be Insolvent by 2019, According to Trustees Reportby 2019, According to Trustees Report

Medicare outlays will exceed income by 2010. The Medicare outlays will exceed income by 2010. The long-term deficit for the program equals 3.54% long-term deficit for the program equals 3.54% of taxable payrolls, and fixing funding for the of taxable payrolls, and fixing funding for the program over the next 75 years would require an program over the next 75 years would require an increase in the Medicare payroll tax from 2.9% increase in the Medicare payroll tax from 2.9% to 6.4% or a 51% reduction in payments to to 6.4% or a 51% reduction in payments to hospitals, nursing homes and home health care.hospitals, nursing homes and home health care.

Medicare & Social Security Board of Medicare & Social Security Board of Trustees Report – May 12, 2009Trustees Report – May 12, 2009

Medicare's Hospital Trust Fund (Part A) Will Be Medicare's Hospital Trust Fund (Part A) Will Be Insolvent by 2017, According to Trustees ReportInsolvent by 2017, According to Trustees Report

Significant growth in the number of people Significant growth in the number of people eligible for Medicare – aging “baby boomers”eligible for Medicare – aging “baby boomers”

Increase in prices as a result of higher wages for Increase in prices as a result of higher wages for health care professionals and inflationhealth care professionals and inflation

Individuals requiring more services (utilization) Individuals requiring more services (utilization) as well as more complex services (intensity) as well as more complex services (intensity)

Health Care Expenditures Health Care Expenditures for Chronic Conditionsfor Chronic Conditions

83% of all Health Care Spending Involved People with Chronic Conditions in 2001

– Medicare – 98%– Medicaid – 83%– Privately Insured – 74%– Uninsured – 72%

Source: Medical Expenditure Panel Survey, 2001, and Partnership for Solutions

Long-Term CareLong-Term Care

• Policy-makers focus a great deal on Policy-makers focus a great deal on Medicaid especially Medicaid LTCMedicaid especially Medicaid LTC

• ““Financing the increasing demand for Financing the increasing demand for long-term care services will be a long-term care services will be a significant 21st century challenge for significant 21st century challenge for the nation.” (GAO-05-564T)the nation.” (GAO-05-564T)

LTC Expenditures: A Lot LTC Expenditures: A Lot Now & Much More in the FutureNow & Much More in the Future

In 1999, CBO projected that total LTC expenditures for In 1999, CBO projected that total LTC expenditures for seniors (including government and private spending but not seniors (including government and private spending but not the value of donated care) would rise from about $123 the value of donated care) would rise from about $123 billion in 2000 to $346 billion by 2040. billion in 2000 to $346 billion by 2040.

That estimate of a relatively modest increase in spending That estimate of a relatively modest increase in spending incorporated the assumption that the prevalence of incorporated the assumption that the prevalence of impairment would decline at a rate of about 1.1 percent per impairment would decline at a rate of about 1.1 percent per year. year.

CBO 2004CBO 2004

LTC = Possibly Much More $$LTC = Possibly Much More $$

If impairment levels instead remain about the same as they If impairment levels instead remain about the same as they are today, expenditures will rise faster, to $484 billion by are today, expenditures will rise faster, to $484 billion by 2040, or about 2.0 percent of GDP. Spending could be 2040, or about 2.0 percent of GDP. Spending could be even higher if, as some researchers believe, the even higher if, as some researchers believe, the prevalence of impairment actually increases in the prevalence of impairment actually increases in the future. Another factor that could translate into higher future. Another factor that could translate into higher spending levels is that the cost of LTC care is likely to spending levels is that the cost of LTC care is likely to increase at a faster rate than that of general price increase at a faster rate than that of general price inflation since historically, the growth of health care costs inflation since historically, the growth of health care costs has outpaced that of the economy in general.has outpaced that of the economy in general.

CBO 2004CBO 2004

Threats to Health Among SeniorsThreats to Health Among Seniors

73% age 65 - 74 report no regular physical activity73% age 65 - 74 report no regular physical activity

81% age 75+ report no regular physical activity81% age 75+ report no regular physical activity

61% - unhealthy weight61% - unhealthy weight

~35% - fall each year~35% - fall each year

20% - clinically significant depression; age group at highest 20% - clinically significant depression; age group at highest risk for suicide risk for suicide

Sources: State of Aging and Health, 2007; www.cdc.gov/nchs; Sources: State of Aging and Health, 2007; www.cdc.gov/nchs; www.cdc.gov/ncipc/olderadults.htmwww.cdc.gov/ncipc/olderadults.htm

What’s the health picture for What’s the health picture for Boomers?Boomers?

By 2030By 2030More than 6 of every 10 will be managing more than More than 6 of every 10 will be managing more than one chronic conditionone chronic condition

14 million (1 out of 4) will be living with diabetes14 million (1 out of 4) will be living with diabetes

>21 million (1 out of 3) will be considered obese >21 million (1 out of 3) will be considered obese – Their health care will cost Medicare 34% more than others Their health care will cost Medicare 34% more than others

26 million (1 out of 2) will have arthritis 26 million (1 out of 2) will have arthritis – Knee replacement surgeries will increase 800% by 2030Knee replacement surgeries will increase 800% by 2030

““When I’m 64: How Boomers Will Change Health Care ”, American Hospital Association, May 2007When I’m 64: How Boomers Will Change Health Care ”, American Hospital Association, May 2007

Obesity* Trends Among U.S. Adults, 1990

No Data <10% 10% –14%

(* BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity* Trends Among U.S. Adults, 1993

No Data <10% 10% –14% 15%–19%

(* BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity* Trends Among U.S. Adults, 1997

No Data <10% 10% –14% 15%–19% 20%

(* BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity* Trends Among U.S. Adults, 2001

(* BMI 30, or ~ 30 lbs overweight for 5’4” woman)

No Data <10% 10% –14% 15%–19% 20%-24% 25%

Source: Behavioral Risk Factor Surveillance System, CDC.

Diabetes Trends Among U.S. Adults,Diabetes Trends Among U.S. Adults,BRFSS 1990, 1996, and 2003BRFSS 1990, 1996, and 2003

19901990 19961996

20032003

No Data <4% 4%–6% 6%–8% 8%–10% >10% No Data <4% 4%–6% 6%–8% 8%–10% >10%

Indicator 28Indicator 28 – Use of Time– Use of Time

A Few Words About PreventionA Few Words About Prevention

Exercise PreventionExercise Prevention

Federal Policy & PreventionFederal Policy & Prevention

– Medicare covers good prevention services, Medicare covers good prevention services, but there’s little promotion but there’s little promotion

– Federal agencies (CDC, AHRQ, AoA) Federal agencies (CDC, AHRQ, AoA) promote evidence-based interventions (note promote evidence-based interventions (note ARC)ARC)

Older Americans Act – only dedicated funding for Older Americans Act – only dedicated funding for HP/DP for elderlyHP/DP for elderly

CDC’s Healthy Aging ProgramCDC’s Healthy Aging Program

– Economic Stimulus legislation provides $1 Economic Stimulus legislation provides $1 billion for new Prevention & Wellness fundbillion for new Prevention & Wellness fund

Prevention & Health Care ReformPrevention & Health Care Reform

Senate HELP Bill (Kennedy)Senate HELP Bill (Kennedy)• Mark up – June 16Mark up – June 16

• National Prevention, Health, Promotion & National Prevention, Health, Promotion & Public Health CouncilPublic Health Council

• National Prevention & Health Promotion National Prevention & Health Promotion StrategyStrategy

• Prevention & Public Health Investment Fund Prevention & Public Health Investment Fund -- $10 billlion per year above FY 2008 levels-- $10 billlion per year above FY 2008 levels

Prevention & Health Care ReformPrevention & Health Care Reform

Senate HELP Bill (Kennedy) – continuedSenate HELP Bill (Kennedy) – continued• ““Independent” Preventive Services Task Independent” Preventive Services Task

Force for CPSForce for CPS• ““Independent” Community Prevention Independent” Community Prevention

Services Task Force for community Services Task Force for community preventive interventionspreventive interventions

• Community Transformation GrantsCommunity Transformation Grants• Healthy Aging, Living Well pilot project for Healthy Aging, Living Well pilot project for

55-64 population55-64 population• Research re E-B practices (esp. for HP Research re E-B practices (esp. for HP

2020)2020)

Prevention & Health Care ReformPrevention & Health Care Reform

• June 8 letter from 236 organizations to June 8 letter from 236 organizations to Kennedy & Enzi (HELP) and Baucus & Kennedy & Enzi (HELP) and Baucus & Grassley (Finance)Grassley (Finance)

• Calls forCalls for• National Prevention StrategyNational Prevention Strategy• Public Health & Wellness Trust FundPublic Health & Wellness Trust Fund

• Trust for America’s Health & RWJF public Trust for America’s Health & RWJF public opinion survey – Americans rank prevention opinion survey – Americans rank prevention as the most important HCR priority & as the most important HCR priority & overwhelmingly support increased funding overwhelmingly support increased funding for prevention to reduce disease & keep for prevention to reduce disease & keep people healthypeople healthy

Evidence-Based & Promising PossibilitiesEvidence-Based & Promising Possibilities- SPARC Model for CPS- SPARC Model for CPS- Green Gym® - Green Gym®

Thank you!Thank you!