Legislation, Presidential & Congressional Politics/Obamacare and Demographics
QUESTION: Mr. Troy, regardless of the most noble intentions behind the Obamacare Law, are the demographics enough to doom it to fail ultimately? I have seen government statistics indicating that the the number of retirees coming to the end of their careers and working life will, in a few years, far exceed the number of younger
workers who will replace them. Furthermore, as we age we tend to need health care more and more. This care will necessarily be funded by the younger workers, whose numbers are diminishing.
I may not have expressed this very well, but I am sure you can see what I am trying to say. I guess the basic question is, did the Obamacare planners fail to consider the demographics? Even if they
later choose a single-payer system, the demographics remain as is.
ANSWER: Hi Frank,
The demographics problem has been an ongoing issue for many reasons. The Affordable Care Act, known as "Obamacare" is actually designed to address some of the problems caused by our aging population.
The elderly have already long been entitled to health care through the Medicare plan, which was started about 50 years ago. The fact that more people in our aging population are getting Medicare benefits, with proportionately fewer younger workers paying Medicare taxes to support them is creating a major funding issue. By requiring more younger workers to buy health insurance, the government is bringing more money into the health care system which benefits older patients who tend to need more care.
The bottom line is that the demographics problem will be with use regardless of which health care system we have. The only way to avoid that is to reduce or deny health care to the elderly and allow them to die off much more quickly. That is not a solution that anyone advocates.
There are some other options, allowing more young working immigrants into the country will help change the demographic balance between working age and retired. We could also rely more on technology. Worker productivity in the industrialized world has continued to grow at a strong rate over the last two centuries. This means that fewer working people can support more non-working people with the resources available.
Under Obamacare, the Dept. of HHS is looking for ways to reduce costs and increase efficiencies, such as doing away with unproductive testing. For example, it was recently recommended that women start getting breast exams later in life and get them every two years instead of each year. This would mean fewer medical care providers are needed to provide the standard care to the growing number of patients who need them. This is only one example of many that are being implemented to try to focus health care resources where they are needed most. There are also incentives built into ObamaCare to reward medical provider for increasing efficiencies while maintaining or improving care.
In short, yes ObamaCare did consider the coming demographic challenges. Whether it did a good enough job or did it in a way acceptable to doctors and patients remains to be seen.
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QUESTION: Thank you for your very prompt response. I am glad that the demographic concerns have been recognized, but there is, as you said, a lot of snags
to be overcome. One major example is the over-testing you mentioned. Doctors and hospitals admit that much of the over-testing is done to avoid culpability (and the likely ensuing lawsuit)if a diagnosis should be missed in the absence of a test. To protect themselves from malpractice
claims providers test for "everything", so to speak. This is well-known, of course, and tort reform is often mentioned, but nothing is ever done because it would require some tough decisions few are willing to make.
There are plenty of other examples, e.g., rationing care, or de facto rationing via long waiting periods, ala U.K., but that's for another day. This is not a question, so no response is expected. I am still wondering why the government is so opaque when they know these and other related
issue are on peoples' minds here, "outside the beltway".
There have been numerous Congressional Committee hearings relating all sorts of issues involving the aging population. But the reality is that politicians do not want to publicize issues too loudly if they do not have a politically popular solution to the problem. Since most solutions in this case mean taking benefits away from people, or taxing the working population at much higher rates, most politicians have little desire to emphasize these options.