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 That prescription might sound upside down: rising longevity often is
used as an argument for delaying Medicare eligibility past age 65.
However, one of the country's top experts on geriatric medicine
actually thinks Medicare should start covering preventive healthcare
when we turn 50.
Dr. Linda Fried, dean of the Mailman School of Public Health at
Columbia University in New York, says that could help people not
just live longer, but enjoy more healthy years. Meanwhile, Medicare
would save money on treatment of chronic illnesses in seniors.
Much of Fried's research is focused on promotion of healthy aging,
and the latest evidence shows people who get to age 60 in relatively
good health are likely to stay healthy.
"The investment would be worth it," she says. "It won't cost
Medicare or the country more money, but having people living not
just longer but healthier is essential to being able to experience
the benefits of longer lives."
Medicare celebrates its 50th anniversary this summer, and its impact
on the health of seniors has been dramatic. Since 1965, people over
age 65 are living longer with far lower rates of death from chronic
disease. The program has evolved and improved along the way, adding
home health services, hospice care and prescription drug coverage,
just to name a few innovations. The anniversary is a great time to
ask what can be done better in the years ahead.
Fried lays out a prevention-oriented vision in an article in a new
issue of the research journal of the American Society on Aging.
The core of her argument: age 50 to 65 is the period of greatest
risk of disability due to cancer, heart disease and stroke, obesity
and diabetes.
"It’s a high-risk group - the time when really bad health things
emerge, and so much of it is completely preventable," she says.
Research also suggests that it is never too late to get results
through prevention.
"Seventy percent of cancers could be prevented if we can get people
to stop smoking and improve their diets," Fried says. "And there’s
clear evidence that a substantial portion of strokes and coronary
heart disease can be avoided by blood pressure screening."
BETTER INSURANCE
The Affordable Care Act already is improving health insurance
coverage in the 50-64 year old population, and a sizeable portion of
the under-65 population is covered through workplace insurance. The
overall percentage of uninsured Americans age 50 to 64 stood at 11
percent last year, down from 14 percent in 2013, according to The
Commonwealth Fund.
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Still, Fried argues many policies leave people under-covered for
preventative medicine, and that Medicare should be reformed to start
interacting with its future enrollees at an earlier age.
She calls for extending clinical prevention to age 50 with a full
set of vaccinations, screenings and preventive services. She also
wants Medicare to cover oral healthcare, vision and hearing
examinations, hearing aids and glasses, all of which are key to
preserving healthy, independent living as we age.
That is just for starters. Fried also envisions getting Medicare
involved in activities that would help seniors maintain physical
health and mental cognitive ability. One way to do that would be to
have Medicare "prescribe and support" programs such as walking
school buses - where seniors get their daily exercise by walking
children to school, or Experience Corps, the senior volunteer
program.
Fried was a co-founder of the Experience Corps in the 1990s, along
with Marc Freedman, founder and Chief Executive Officer of
Encore.org.
The program trains older adult volunteers to work with low-income
students in public elementary schools, but it also was designed to
be a public health intervention aimed at improving cognitive ability
and social activity for older people. Research has documented higher
levels of physical metabolism and improved cognitive function in
volunteers who spend 15 hours weekly with Experience Corps.
Fried thinks Medicare could even provide incentives to get people
involved.
"Medicare could cover your co-pays for every year of volunteer work,
or even a year or two of free Part B coverage. It would be a great
way to invest in the health of enrollees," she says.
(The writer is a Reuters columnist. The opinions expressed are his
own.)
(Editing by Beth Pinsker, Lauren Young and Andre Grenon)
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