The 50th anniversary of Medicare next month is an opportunity to consider what the goals of medicine should be in our aging society and how we want to live in relation to medicine’s evolving tools.(continues)
There has been a revolution in medicine and in patient expectations since President Lyndon B. Johnson signed Medicare health insurance into law on July 30, 1965, setting off the often contentious debates about cost control, rationing and privatization now dominating the public conversation about health care. To craft Medicare’s best possible future, however, it may be more productive to focus on the kinds of health care older Americans are actually receiving and are claiming to want.
Consider how much patients, doctors and treatments have changed since 1965:
The United States population is growing and aging. In 1965, fewer than 10 percent of Americans were 65 and older; fewer than 1 percent were 85 and older. Today those figures are 13 percent and 2 percent, respectively, and the latter cohort is the country’s fastest-growing age group. By 2030, people 65 and over are projected to represent 20 percent of the total United States population.
Our aging population has become increasingly medically sophisticated, risk aware and demanding about treatments. The paternalistic physician who knew the patient and family and “made the decisions” into the 1960s has been succeeded by a culture of patient autonomy, hospital-centered medicine and the new importance of medical teams.