Consulo Indicium - 8/29/25

Information for your Consideration… 

Lest We Forget – I will never forget Martin Luther King’s “I Have A Dream” speech given from the steps of the Lincoln Memorial on August 28, 1968. It is a speech that none of us should ever forget. The power of his commitment, the strength of the people standing before him, and the need for all Americans to witness and experience the true potential of the United States of America were compelling. In these current, equally compelling times, we should not forget that “a man (and woman) should be measured by the strength of his character rather than the color of the skin” or any other measure we might conjure up… 

Wow!! – A $37 Trillion Deficit – When one digs into the recent announcement on the staggering amount of debt owed by the United States, it’s a bit difficult to determine all of reasons why we’ve accumulated such a large amount. However, “health care” writ large is one of the reasons and, it appears to be among the largest and fastest-growing drivers of federal spending. Check out these facts:

Metric	Approximate Value	Notes & Source
Annual federal health spending (FY 2024)	~$1.9 trillion	~27% of overall federal spending Kaiser Family Foundation
Total annual federal health support (incl. tax subsidies)	Over ~$2 trillion	Includes indirect effects Bipartisan Policy Center
Medicare & Medicaid growth since 2000	From ~3.1% to ~5.6% of GDP	Reflects rising federal burden The Wall Street Journal
Projected federal health share of outlays by 2055	~30%	Indicates long-term trend Peterson Foundation
Estimated portion of debt tied to health costs	Likely a major share – estimated @ 20–30% of the $37 trillion	Based on annual deficits and spending patterns

Given the proportion of the annual cost of health care in the annual budget, it’s clear that unless something is done, health care will continue contributing significantly to the accumulation of our national debt over time – likely representing a substantial portion of the anticipated increase in that $37 trillion that already lies there in front of us! But, the issue does not hang around the neck of seniors. Rather, Congress has gotten into a habitual process of dipping into the SSA reserves to “borrow” funds to cover the national debt (i.e. “robbing Peter to pay Paul” so to speak). It’s been a shell game because the powers that be – on both sides of the aisle – have been reluctant to bring the real issue forward to the American people. But, my argument is – now is the time.

However, before I take us to a potential solution, let’s consider the impact of the programs on the health of the nation:

SSA Offers Stability for Elders and the Disabled – Social Security is a government program that each and every one of us who are employed contributes to throughout their lifetime. It’s the “forced” retirement package so that when our earning years begin to decline, we have a nest egg we can dip into for ongoing financial resources. For example, I was a contributor and, now I’m a dipper. The Social Security Administration (SSA) is reaching an important milestone this year as it celebrates its 90^th birthday. I don’t think I’m overstating when I note that the SSA is one of the most remarkable programs in the world. Since the founding of the program in 1935, Social Security has served as the primary cornerstone of economic security for millions of Americans. It has assisted our older cohort of American citizens to retire with dignity as well as providing support to those with disabilities and families in their transitions after the loss of a loved one. In today’s world, roughly 67 million or 19.7% of American citizens receive benefits from the program. Not only is it the bedrock support for the retirement years but it also offers “stability and care in uncertain times”. I started contributing to the program when I was 13 years of age with my first job (aside from delivering papers on a daily basis for the 4 years prior) at our local grocery store [NOTE: we started young back in those days]. At the time, I wondered why I was doing this. Now, a bunch of years later, I totally understand.

Health Coverage Expansion – The same goes for Medicare (1960) and Medicaid (also, 1960) – two of the most important health care programs in the USA. They were created under President Lyndon B. Johnson’s “Great Society” programs and, have had deep and lasting impacts on the USA population across the spectrum of health, economics, and social equity. Before 1965, roughly half of Americans over 65 had no health insurance, and seniors often faced poverty due to medical bills. Today, nearly all older Americans are covered through Medicare, dramatically reducing uninsured rates in this group. Kudos to the policymakers for creating such a successful program.

Medicaid then followed as a program to support low-income individuals, families, and people with disabilities. Originally, it was a rather small program but over the years has grown to now cover 1 in 4 Americans, including many children, pregnant women and individuals with chronic illnesses. The Affordable Care Act (2010) expanded eligibility in many states and significantly increased coverage for low-income adults. Now, I realize there are lots of perspectives about this program in particular but I was always taught to “love one another as ourselves” – and, it seems to me that if we want to have a “society”, providing some assurance that all of us have “some” access to resources and “some” measure of support from the society is an obligation as part of our membership in that society. But, let me get back to details rather than devolving into “preaching” mode…

Societal Health Outcomes and Longevity Have Increased – Since the 1960s, a person reaching 65 could expect to live another 14 years but today it’s closer to 20 years. Why? Because access to hospital care, preventive services, and prescription drugs through Medicare has made a major contribution by providing access to care. And, it’s not just the elderly. It’s also infants and children through the Medicaid program where access to good prenatal and pediatric care has reduced infant mortality and improved early childhood health outcomes.

Enhanced Economic Security – Prior to the provision of Medicare, medical costs were a leading cause of elderly poverty. Furthermore, Medicaid plays a major role in keeping low-income families above the poverty line by covering medical costs that would otherwise be catastrophic. And, the coverage has extended across all segments of our society from the central city to the remote hinterlands of the rural areas across the nation. 

Social Equity and Inclusion – I’ve already laid my cards on the table so harangue me if you will…but, I do believe in “social compacts”. As I’ve traveled around the world, I have been proud of our accomplishments as a society on “diversity”, “equity” and “inclusion”. So, despise me if you want but, the whole of society has improved through desegregation which created an avenue for those less fortunate by accelerating racial integration in healthcare in the late 1960s. And, as I’ve noted, it was not only “racial” integration but also the integration of people with disabilities and others in need of adequate care. 

So, let’s cut to the chase! The elephant in the room is that Medicare and Medicaid together now account for about one-quarter of our total federal spending. That’s an enormous anchor around the neck of the American people and the Congress who is responsible for setting policy. It’s also easy to lay off the problem onto the disabled, the newborn infants, children living in poverty, those who are unemployed because they are in many, many respects far less powerful and their voices are often not heard nearly so well in the halls of the U.S. Congress…so, it’s easier to pass the buck onto the weak among us.

Which takes us to a potential solution that will mitigate some of the problems and, simultaneously, push in a different direction by enhancing value and decreasing costs simultaneously. And, that solution is to begin a very serious discussion about moving health care towards a “value-based” payment for services that supports quality, addresses social determinants of health (SDOH) – which are a known commodity for increasing the cost of care, provides for equity and encourages efficiency. It’s a discussion that is percolating up but needs a higher temperature on the burner!! And, the growing federal deficit is that kind of burner.

In fact, we don’t have clear answers on how to effectively implement “value-based care”. So, let’s facilitate experimentation. Let’s create SDOH mitigation programs. Let’s look at more efficient ways of offering care. Let’s put it all on the table. And, who is the “us”? It’s the healthcare community. It’s our responsibility as professionals providing the care for all and as members of society to show that we can help solve the problem. And, finally, within that dialogue I’m confident that we will identify other solutions that help move the needle and make all of us stronger and better by making our society better and stronger. Enough said!! 

In sum, I am arguing that Medicare and Medicaid fundamentally changed the U.S. social contract by making healthcare a guaranteed right for older adults, people with disabilities, children, and many low-income Americans. Those programs have extended life expectancy, reduced poverty, improved health equity, and reshaped the healthcare system – while also introducing significant fiscal and policy challenges that continue today. It’s time for the healthcare community to step up and find the solutions…

Unvaccinated Patients Willing To Be Immunized During ED Visits – A new study was recently published in the CDC’s Morbidity and Mortality Weekly Report. A survey was conducted during emergency department-based visits by more than 3,000 adult patients. The survey revealed that nearly 90% had missed at least one CDC-recommended vaccine and nearly half (46.4%) indicated that they were willing to obtain the vaccinations based on the CDC recommendations for their particular age group. It’s a lesson for the office. If you simply “ask”, they may follow through. Consider it…

Extending Our Care – Like many of my readers, I am the proud parent of two Glen of Imaal Terriers! Because of the rarity of their breed in the USA, I am frequently asked about them. I’ve actually prepared business cards with their pictures and, an explanation. In addition, we frequently introduce them as our “retirement children”. Toto (= Toran Torme) and Lole (Locklan Leigh) are truly the most wonderful companions. So, why are they mentioned in my blog which is focused on health care? It’s because of an interesting finding that I learned about through the South China Morning Post via Getty Images. Unbeknownst to me, about 3 million Americans live with cardiac pacemakers. They are the small, implanted discs that keep many – including me – alive with a regular heartbeat by offering a stimulus if the heart rate slows down too much. I can personally attest to their effectiveness!! And, they have literally improved the quality of life for many, many of those Americans. BUT, did you know that these same devices can be reused in dogs​ by simply donating them to veterinary clinics with dog cardiologists? Yes, indeed!! Even though Toto and Lole will not live as long as me, they may outlive me. I’m checking this one out further… 😊

Reducing Cognitive Impairment Risk Among Older Adults – The August 9 issues of  The New York Times reported a recent study reported in Nature Human Behavior on 57 studies suggesting that the use of everyday digital technology is associated with reduced risk of cognitive impairment and dementia among older adults. Specifically, it was noted that people over age 50 that use “… computers, smartphones, the internet or a mix did better on cognitive tests, with lower rates of cognitive impairment or dementia diagnoses, than those who avoided technology or used it less often.” Nearly 90% of the studies analyzed noted the “protective cognitive effect” derived from the ongoing use of digital technologies in everyday life. It was also noted that the use of digital technology “…may also protect brain health by fostering social connections, known to help stave off cognitive decline.” So, I guess I’ll stick with it for a bit longer…