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employee to limit the employers’ exposure to annual double-digit inflationary increases. One of the first casualties of this shift is coverage for the employees’ spouses and children. Another complicating factor is that many technology-related jobs are now provided on a contractual basis and do not have health care benefits. The problem of the uninsured, which used to be correlated with low family incomes, is now expanding to middle income families.
The driving force for all societal decisions for the next 25 years will be the growth of the elderly population. In 2011, the “baby boomers” will begin to turn 65. The over-65 age group will continue to grow as a percentage of the U.S. population until 2026. This will create an exponential increase in the demand for all social supports – particularly health care. The federal government has already taken steps to limit the demands placed on federal health care resources. It has indexed Medicare increases to be less than economic growth even though the demand for health care is generally inversely related to economic growth. The federal government has also proposed a “block grant” contribution for state Medicaid programs that is generous in the early years, but limits federal expenditures in later years when demands on the Medicaid program will increase. Thus far, the states have not been tempted by this offer despite their dire Medicaid shortfalls.
The Medicaid program will be particularly challenged by the aging of the population because it covers two major services that are not covered by Medicare – pharmacy and long-term care. As the population ages, the demand for these services will increase. The states are arguing that the federal Medicare program should assume responsibility for these services for Medicare eligibles in order to provide fiscal relief to enfeebled state budgets. The federal government remains unconvinced.
We stand between an irresistible force and an immovable object: First, senior citizens are entitled to the health benefits that they have been promised and have been funding since 1965. Second, children are the best place to invest to assure the future. Currently, we lack the political awareness, the political courage and the vision to deal with the impending conclusion. The danger exists that – in a world of limited health care resources – the large, articulate and well-financed senior citizen lobby will pull scarce resources from the less organized groups that lack a political voice: children and the poor.
For those of us who care about the health of children, it is good to remember that the challenges are political as well as clinical, and solutions are found in political science as well as medical science. When the debate on how to distribute limited health care resources takes place, I want to be sure that osteopathic physicians are an advocate with a clear and united voice for fair treatment of all members of our society.
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