Why Older Adults Can’t Get Care – The Caring Generation®
The Caring Generation® – Episode 105 September 29, 2021. On this episode, Why Older Adults Can’t Get Care, caregiving expert and host Pamela D Wilson shares insights into difficulties experienced by older adults attempting to navigate the healthcare system and the benefit of having a primary caregiver. Guest Dr. Edward Hoffer explains why healthcare is so expensive and discusses actions that consumers can take to advocate for change.
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Why Older Adults Can’t Get Care
0:00:04.0 Announcer: Caregiving can sometimes feel like an impossible struggle. Caregivers may be torn between taking care of loved ones and trying to maintain balance in life. The good news is that it doesn’t have to be that way. The Caring Generation, with host Pamela D. Wilson, is here to focus on the conversation of caring. You’re not alone. In fact, you’re in exactly the right place to share stories and learn tips and resources to help you and your loved ones. So now, please welcome the host of The Caring Generation, Pamela D. Wilson.
Common Problems Faced by Older Adults Who Attempt to Navigate the Healthcare System
0:00:37:22 Pamela D Wilson: This is Pamela D. Wilson, caregiving expert, speaker, consultant, and guardian of The Caring Generation. The Caring Generation focuses on the conversation of caring. Giving us permission to talk about aging, the challenges of caregiving, and everything in between. It’s no surprise that needing care or becoming a caregiver changes everything. The Caring Generation is here to guide you along the journey to let you know that you’re not alone.
0:01:04:04 Pamela D Wilson: You’re in exactly the right place to share stories, learn about caregiving programs and resources to help you and your loved ones plan for what’s ahead. Invite your aging parents, spouses, family, and friends to listen to the show. If you have a question or an idea for a future show, share your idea with me by responding to my social media posts on Facebook, Instagram, Twitter, or Linked In.
0:01:30:90 Pamela D Wilson: Today, we’re talking about why older adults can’t get care to answer the question of why is having a primary caregiver important. Older adults who live alone or are married may find interactions with the healthcare system problem-free until a health diagnosis begins to cause challenges with getting care or learning the actions to take to resolve health issues. I’ll share eight reasons why older adults can’t get care and things you can do to advocate for yourself or a loved one.
0:02:08:99 Pamela D Wilson: The healthcare system of hospitals, doctors, pharmacies, and insurance companies can add to the reasons why older adults can’t get care. Joining us to share basic but relatively unknown reasons for why healthcare is so expensive and what consumers can do is Dr. Edward Hoffer. Dr. Hoffer earned his Bachelor of Science in Planning degree from MIT and his medical degree from Harvard Medical School and completed his residency training in Medicine at Massachusetts General Hospital, where he has been involved there in research for 50 years.
0:02:51:43 Pamela D Wilson: In addition to his work in medical informatics, he maintains a clinical practice of Cardiology and Internal Medicine in Framingham. He is an Associate Clinical Professor of Medicine at Harvard, performing ward rounds, delivering lectures, and conducting case conferences. He has taught both physicians and the lay public through formal Grand Rounds and public lectures, focusing on his clinical areas of interest in atrial fibrillation and geriatric cardiology. He has also contributed via committee work and leadership roles at the hospital, state, and national levels.
0:03:32:03 Pamela D Wilson: Our discussion answers questions that many caregivers ask and features information from his book Prescription for Bankruptcy: A Doctor’s Perspective on America’s Failing Healthcare System and How We Can Fix It. You can find this on Amazon, including links to his blog posts. Let’s begin with reason number one for why older adults can’t get care. Most consumers and this is not limited to older adults, are not Health or healthcare savvy.
0:04:03:45 Pamela D Wilson: Until there is an interest or a problem, there is usually no reason to pay attention to a topic like health or healthcare. Older adults can’t get care because most have limited experience with health prevention or seeing doctors until something goes wrong. A diagnosis of dementia, a heart attack, or something else. And even if you have high blood pressure or another diagnosis, you may only see your doctor every 6-12 months to get your prescriptions refilled at a 15-minute appointment.
0:04:40:16 Pamela D Wilson: So I think we can say that this infrequent amount of contact means that caregivers and aging adults are not healthcare savvy. When you think about it, who wants to spend more time with the healthcare system? No one. I think we would all prefer to remain healthy and out of doctor’s offices, nursing homes, and hospitals. This is where it gets tricky.
0:05:09:33 Pamela D Wilson: The reason older adults can’t get care and that you, as their caregivers, struggle to get care is that most consumers don’t know enough about health and well-being. Unless you are a nurse, a doctor, or a professional who has regular contact with the elderly in their homes or healthcare settings—most family members do not have this level of experience.
0:05:35:88 Pamela D Wilson: You don’t have all of the knowledge needed to remove barriers to care for the elderly or yourself. Instead, you may play catch up to learn more about a disease diagnosis and the actions you could have taken before now to ensure that heart disease or another condition didn’t worsen. Because time at medical appointments is so limited, many caregivers and older adults search for health information on their own.
0:06:06:33 Pamela D Wilson: Three of the most common wants from caregivers include education or training about caring for aging loved ones, identifying and finding community resources, and support planning for the health issues of loved ones specific to chronic diseases. How many of you agree with this wish list? Many caregivers I communicate with in my online support groups, social media, consultations, or conversations don’t realize that information or support exists.
0:06:44:15 Pamela D Wilson: In my opinion, this is because the contributions of family caregivers go unrecognized. Many caregivers work. Workplaces offer few programs specific to eldercare. The healthcare system: hospitals, doctors, insurance companies treat medical diagnoses and they don’t go beyond this to provide the support that can have the greatest effect to resolve why older adults can’t get care.
0:07:17:47 Pamela D Wilson: This takes us back to consumer responsibility for health and learning to navigate the healthcare system. As you will hear Dr. Hoffer mention in our discussion in the second half of the program, healthcare consumers are at a significant disadvantage when dealing with hospital systems, insurance, pharmaceutical companies, and other senior care providers because of lower levels of education and savvy.
0:07:47:20 Pamela D Wilson: Consumers cannot compete with the lobbyists and special interest groups representing these large companies. Competing on uneven ground means that caregivers and older adults have to work harder and become more educated to advocate and get the care they want. While many caregivers may not yet have been exposed to health insurance company denials, runarounds trying to get prescription refills or other providers who deny care or claims without detailed explanations.
0:08:20:98 Pamela D Wilson: If you care for an aging parent or need care, it is likely you will run into these issues. Reason #2 for why older adults can’t get care. You and your caregivers don’t know the questions to ask. Think about your experience with doctors or anyone in the healthcare system. They are time-limited. Their job is to speak with you, address your concerns, and send you off as quickly as possible. Healthcare interactions mean getting you off the phone as quickly as possible.
0:08:48:82 Pamela D Wilson: My advice—don’t let them send you away until you have all of your questions answered. The key is to have a list of questions prepared, and if one person runs out of time to ask, who is the next person that can help you? If you are at a doctor’s office, don’t rush to leave. Make a follow-up appointment if that’s what it takes to get your questions answered to your satisfaction.
0:08:00:00 Pamela D Wilson: If you are on the telephone, ask for a supervisor or the next person to answer your question. Don’t be in a rush, even though I know many of you are time-limited. Caregivers and older adults who get the care they want are polite, tenacious, and thankful. Learn who can help you and thank them. There is nothing wrong with saying, “are you the person who can help me with this, or should I be talking to someone else?”
0:09:36:50 Pamela D Wilson: For example, I was on the telephone for 2 hours last week being transferred back and forth or having a 3-way call with an insurance company and a pharmacy. I acted like I had all of the time in the world—which I did not. But I wasn’t going away until someone recognized and resolved my issue or at least had a plan to resolve my problem.
0:09:58:99 Pamela D Wilson: This particular situation involved understanding why the issue occurred and asking for the insurance company and the pharmacy plan to offer a specific solution. Believe it or not, I had to repeat the situation and the cause every time I got transferred to the next person, which was about 8 or 9 times. The next person I spoke with kept assuming that I did not understand the issue, which I did.
0:10:24:42 Pamela D Wilson: What they had trouble understanding was that I wasn’t going away until they answered my questions or offered a plan to resolve the issue. When they finally figured out that I wasn’t going to hang up until someone took my situation seriously, I got transferred up to the next supervisor and up to the next supervisor who finally answered my questions.
0:10:46:04 Pamela D Wilson: Many older adults and caregivers can’t get the care they want because of not being specific about what you want or not investigating and understanding the situation thoroughly so that you can explain it back to the healthcare providers who assume you do not know what you are talking about. There are no shortcuts to getting the care that you want. As consumers, you have to do the work because the healthcare system is too rushed to help you, and the people you talk to may not be able or may be unwilling to help you.
0:11:21:03 Pamela D Wilson: While I know this is frustrating if you are a caregiver, don’t give up. Don’t become a contributing factor for why you or older adults can’t get care. We’re off to a break. If you are looking for help navigating the healthcare system, decision-making about care for elderly parents, or making a care plan for yourself, I can help. Visit my website PamelaDWilson.com and schedule an eldercare consultation.
0:11:44:57 Pamela D Wilson: Click on How I Help, next Family Caregivers, and next Eldercare Consultation. This is Pamela Wilson, caregiving expert, author, and speaker on The Caring Generation. Stay with me; I’ll be right back.
0:12:25:65 Pamela D Wilson: This is Pamela Wilson on The Caring Generation. Help others who may be dealing with health, aging, or caregiving issues by sharing information about this show.
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0:12:45:12 Pamela D Wilson: We’re returning to talk about why older adults can’t get care. Number three follows number one – which is not being health savvy, and number two not knowing the questions to ask. Reason three for why older adults can’t get care is being afraid or hesitant to question physicians and other people because you are not educated or don’t want to look silly.
0:13:23:65 Pamela D Wilson: When it comes to your health, if you are not a doctor, nurse, or other healthcare professionals, you are not as educated as you would need to be to feel like you are a professional equal. In reality, you are the patient. You’re not expected to be medically educated. This is the reason consumers go to see doctors and other professionals like myself.
0:13:48:55 Pamela D Wilson: We have education and knowledge to offer to people who seek the support and assistance we offer. Let’s talk about the feeling silly component of why older adults can’t get care. While this may be difficult to understand, doctors have heard and seen just about everything. There is no need to be embarrassed about the problem or need that sends you to the doctor’s office if this is the first time you’re seeing your doctor for this issue.
0:14:21:08 Pamela D Wilson: If this is a repeat concern and you are returning to the doctor, the best course of action to take is to explain that you followed doctor’s orders (assuming that you did and you didn’t ignore the doctor’s advice) and why you are experiencing ongoing concerns. If you have questions, get them answered. Most people do nothing.
0:14:47:20 Pamela D Wilson: Do nothing because making any changes to a routine or lifestyle can be uncomfortable if you don’t fully understand the reason for the change, the benefits of the change, or the consequences of not making the change. Never be afraid to ask questions. Not asking is the thing that you do to prevent you from getting the results you want. Consumers, patients, older adults must participate in their care to get the care they want.
0:15:18:16 Pamela D Wilson: Number four for why older adults can’t get care is not having an advocate who won’t give up. Honestly, you need a tenacious person to be your primary caregiver. If you are by yourself, then this tenacious person must be you! When a person ages and has health issues, especially memory loss, it can be difficult to continue to learn about health issues, ask questions, and have the energy and patience not to give up.
0:15:50:14 Pamela D Wilson: It’s the idea of saying, “I’ve got all day to resolve this issue. Can you help me, or should I talk to someone else?” Now, I know you don’t have all day, but if you have an issue, it’s important to make it clear to the other person that you are committed to getting a response or a resolution. Know that this can take questioning and problem-solving skills to determine why an insurance claim was not approved and to speak with someone who can explain this to you in a simple manner so that you can explain this to the next person you speak with.
0:16:27:13 Pamela D Wilson: The same goes for dealing with companies in the healthcare system for any challenge Let’s say you want to arrange in-home care or move a parent to an assisted living community, and you keep getting transferred around from person to person. Everyone seems helpful, but no one is following through. All of a sudden you get a call from the agency or company saying that you are being difficult or expecting too much and they can’t meet your needs.
0:16:55:30 Pamela D Wilson: All the while, everyone you spoke to never indicated that there was any problem with your requests. You feel that your actions were appropriate. What do you do? Drop it and move on or request a meeting to review the concerns? One of the reasons older adults can’t get care is that they don’t stand up for themselves or have a primary caregiver or advocate with the skills to resolve conflict.
0:17:25:36 Pamela D Wilson: Think of working with the healthcare system this way. They offer a product that consumers need. Healthcare providers don’t want to negotiate because they don’t have to. There are 100 people behind you wanting assistance. If you are perceived as a problem through your interactions with them or if they can get you off the phone quickly or off their list quickly, that’s exactly what they want to do.
0:17:51:60 Pamela D Wilson: Companies whose services are commodities, like healthcare, especially those who set their rates and you have no control over the charges, don’t need to have great customer services because they don’t have a shortage of customers. Consumers, patients, and the elderly are at a disadvantage because you need the healthcare system.
0:18:15:66 Pamela D Wilson: Your challenge is to learn as much as you can to position your needs in a way that providers understand what you want and are willing to work with you. Reasons that older adults can’t get care is because older adults can become impatient, forgetful, not follow through, and forget who they spoke to on the last phone call to the doctor’s office. If you’re not good with details and follow-through, it’s going to be challenging to get the care you want.
0:18:47:73 Pamela D Wilson: If you are an older person by yourself, you may need to hire a caregiving advocate. The money you spend can save you hours of time. Caregiving experts like myself who have tens of thousands of hours of experience know how to work with a variety of healthcare providers, and we speak the same language. Family caregivers I work with often cite frustration as the reason for giving up.
0:19:13:88 Pamela D Wilson: If you give up, who wins and who loses? You or an aging parent loses. The healthcare system wins. I believe that every person deserves care no matter the age. While the healthcare system usually favors young lives over old lives, if you have a primary caregiver or an advocate, you are more likely to receive the care you need. I have been in situations where doctors or other healthcare providers have declined care for my client.
0:19:46:41 Pamela D Wilson: Because I was the power of attorney or court-appointed guardian, I never took “no” for no. I was persistent. Asked for meetings. Requested information about the reason the doctor or provider made the recommendation or declined care for my client. In most cases, I was able to present enough information so that my client received the necessary treatment or care.
0:20:13:66 Pamela D Wilson: There are times when you may have to be a little flexible on parts of the solution to arrive at the best-case scenario. Learn to be flexible so that the bigger goal is achieved. Here’s a non-related example, but one that may be helpful. A son caring for a mom with dementia has to take mom to the doctor. Mom continually fusses about putting on her shoes and socks causing delays in leaving the home to go to the doctor appointment.
0:20:41:05 Pamela D Wilson: What’s the issue? Is the issue that mom doesn’t want to go to the doctor? Maybe. Is the problem that mom’s shoes and socks are not comfortable? Maybe. Might there be something else going on? Maybe? What would you do being the son in this position? Would you argue with mom and tell her she has to put on her shoes and socks?
0:21:04:96 Pamela D Wilson: Does mom really have to wear shoes and socks? Can she wear slippers? Can she put something on her feet so that you can get her into the car and then allow her to fuss with her shoes and socks? Is there a wheelchair at the doctor’s office you can use in the event she still refuses to put on her shoes and her socks? Are you really going to let an argument about shoes and socks result in mom not going to a doctor’s appointment?
0:21:35:05 Pamela D Wilson: Is winning the battle over shoes and socks the most important thing or is the most important thing having mom see the doctor. There are times when all of us can get stuck on some small detail that really has no effect on the outcome or result that we want. The key is to know what you want and to be as flexible as possible to achieve the goal you want.
0:22:00:31 Pamela D Wilson: If you are negotiating with a provider, it’s okay to say, “we both want the same thing. What flexibility is it going to take to get there?” You may be able to work out the situation with minor compromises, or you may learn that because of rules or regulations, the “thing” you want isn’t possible. If this is the case, then ask the question, “what is possible, what can be done, what are the options.” And don’t give up. We’re off to another break.
0:22:33:76 Pamela D Wilson: Thank you for following and communicating with me on social media – Facebook, Twitter, Instagram, Linked In, and YouTube to ask questions and provide questions and topics for this podcast, videos, and articles on my website. You can also complete the caregiver survey on my website pameladwilson.com to offer thoughts, suggestions, and information. I’m Pamela D Wilson on The Caring Generation. Stay with me; I’ll be right back.
0:23:27:99 Pamela D Wilson: This is Pamela D Wilson on the Caring Generation. Tips, articles, videos, this podcast, my book The Caregiving Trap: Solutions for Life’s Unexpected Changes, online courses about becoming a guardian, and actions to help yourself or an aging parent live independently at home are all on my website at pameladwilson.com. Please share this show and information with others you know who are seeking,
0:23:54:28 Pamela D Wilson: hope help and support. Research confirms that many people helping or caring for elderly parents don’t know who to trust for education, resources, or accurate information about caregiving, aging, family relationships, and everything in between. You’re here with me on The Caring Generation. Trusted information is here. Let’s talk more about why older adults can’t get care. There are many barriers to care for older adults. Within the healthcare system, there can be inappropriate attitudes or negative biases against the elderly.
0:24:33:15 Pamela D Wilson: Many healthcare workers lack training or sensitivity to the needs of older adults, especially those diagnosed with dementia who may forget or repeat information. Older adults, more than the young, need specialized care due to having a greater number of chronic health conditions that require more time. Because some doctors and nurses may believe that care for the elderly is not worth the effort or that older people are closer to death, they may not be willing to address healthcare needs but instead, recommend hospice or end-of-life care.
0:25:14:03 Pamela D Wilson: I know this happens because I’ve experienced healthcare bias against the elderly when I was responsible for managing the care of my clients. As consumers, caregivers, and older adults, it’s important that you are aware that these issues can happen so that you have a plan for how to respond. Physicians and nurses can have the general opinion that hospitalized older adults have irreversible conditions and may not respond to care and treatments.
0:25:46:15 Pamela D Wilson: There may be a belief that older adults are not useful anymore and that treatment and equipment should be used only for younger patients. Older adults who are sick are generally unable to advocate for themselves. If you are an older adult who does not have a primary caregiver to advocate for you or someone you have appointed as a medical power of attorney – it is important not to wait to find someone to speak up for you if you want to receive good care.
0:26:16:11 Pamela D Wilson: With all of this in mind, reasons, why older adults can’t get care include a lack of participation or follow through with the prior recommendations of physicians or a lack of self-care. Additionally, the general health of all patients, their activity levels, nutrition habits, weight, and routines are considered when doctors make medical care recommendations. An older adult who is physically active, walking several miles a day, will be more likely considered for hip replacement surgery than an aging adult who sits at home all day, is overweight, and inactive.
0:27:00:44 Pamela D Wilson: Let’s look at health observations by society and related these to medical care. Consumers and society treat obese people differently. People who have larger than normal body sizes suffer discrimination, prejudice, and humiliation in many areas of life. Weight stigma has significant effects on larger than normal people. According to an article “What does fat discrimination look like,” women in professional occupations face more discrimination than thinner colleagues.
0:27:39:89 Pamela D Wilson: Overweight people feel self-conscious about going out in public to grocery shop or eat at a restaurant. Society makes fun of overweight people for failing to control their eating habits. Overweight persons avoid attending medical appointments because of fear of being judged negatively by doctors, who may be overweight themselves. This means that overweight persons may not receive medication treatment for conditions they already have that have the potential to worsen.
0:28:12:16 Pamela D Wilson: The healthcare system is imperfect. Many consumers view the healthcare system as an authority because of declines for care requests and other challenges. The number five reason for why older adults can’t get care is that they give up too easily. Many parts of life have an associated hassle factor. When we are young, we may be more resilient and not give up as easily. Experience can lead to understanding that most people will give up if told no—or if additional effort is necessary to achieve a goal.
0:28:51:37 Pamela D Wilson: Part of achieving what you want is to develop an attitude of not giving up. Another reason is not having the discipline to see a project through until its end. How many people do you know who get excited about something —joining a gym, beginning a craft project, learning how to play the guitar, and then four weeks later, they give up because it’s too difficult or it’s too much effort.
0:29:20:170 Pamela D Wilson: When we see others who make doing something look easy, we can experience a tingle of jealousy. How many of us have ever said to ourselves, “wow, this is harder than I thought, or I can’t do this. What was I thinking?” Being persistent at anything, including becoming a healthcare advocate for yourself or another person, involves a mindset and a belief system that says, “when things get tough, I will keep going.” It’s having a belief system that recognizes that every problem has a solution.
0:30:00:99 Pamela D Wilson: In my opinion, making mistakes are an opportunity to learn what works and what doesn’t work. You simply stop doing what you know doesn’t work. Specific to why older adults can’t get care – this goal also includes having an open mind. Being stuck in a habit for forty years can be hard to change when the doctor tells you that strength training exercises will reduce back or arthritis pain, and that seems like a lot of effort.
0:30:38:55 Pamela D Wilson: The tipping point for older adults to get good care is desire and persistence. This includes the discipline to keep going even on days when you’d rather stay in bed and eat ice cream or munch on a bag of potato chips. There is no easy road to living a healthy life. It is much easier if you learn about health and what it takes to stay healthy when you are young so that by the time you reach retirement age, you’re healthier and more active than most of your peers.
0:31:11:71 Pamela D Wilson: While we can’t turn back the clock, we can change where we are today. On this topic, joining us after this break is Dr. Edward Hoffer. Many caregivers I speak with are frustrated by the healthcare system but lack an understanding of the issues. We’ll talk about why healthcare is so expensive and why consumers seem to be getting less and less care.
0:31:38:69 Pamela D Wilson: Many of the healthcare conversations that occur are politically motivated and not explained in a way that is easy to understand by consumers who are the most negatively affected. Stay with me to learn why healthcare continues to be a hot topic in the United States. Share this episode and over 100 episodes of The Caring Generation with family, friends, and your workplace to make healthcare, aging, and caregiving education accessible for everyone. This is Pamela D Wilson on the Caring Generation. Stay with me I’ll be right back.
0:32:40:92 Pamela D Wilson: This is Pamela D Wilson on The Caring Generation, available worldwide on your favorite music and podcast apps. Listen and follow the program for proven, reliable tips, information, resources, and research about caregiving, aging, health, and everything in between. To answer the question of why is healthcare so expensive, I’d like you to meet Dr. Edward Hoffer.
0:33:33:96 Pamela D Wilson: Dr. Hoffer thank you so much for joining me.
0:33:12:50 Dr. Edward Hoffer: My pleasure.
0:33:14:19 Pamela D Wilson: The healthcare and the pharmacy lobby have significant power because they contribute to the government, re-electing senators, state representatives, governors. What about these relationships makes it difficult for elected officials to truly represent the interests and needs of consumers specific to healthcare?
0:33:33:96 Dr. Edward Hoffer: When you look at what determines the regulations, rules governing healthcare, you have really an unfair fight. The, I heard a very wonderful analogy, it’s in the United States we call it lobbying. When the same practices happen in countries abroad, we call it graft and corruption. What you have, when I say it’s an unfair fight, is on one side you have the general public—and the general public are not terribly well organized.
0:34:18:92 Dr. Edward Hoffer: They have no common voice. And for the vast majority of Americans, healthcare costs is just one of numerous worries. So, they’re not going to focus on that to the exclusion of other things. And on the other side, you have the highly organized, highly motivated special interests with very deep pockets. Among the top five lobbying groups in Washington are the pharmaceutical industry, the hospital industry, and health insurers.
0:34:54:04 Dr. Edward Hoffer: And these people go in there with lots of money and to think that our senators and representatives will ignore the people who are funding their campaigns to do something for the public good is, I’m afraid overly optimistic. Money talks and the people who are contributing to the high cost of care essentially buy their way into getting what they want
0:35:28:70 Pamela D Wilson: And, why is healthcare so expensive?
0:35:31:46 Dr. Edward Hoffer: I don’t know whether all of your listeners realize it, but healthcare spending in the United States is grossly excessive compared to the rest of the world. If you look at the U.S. versus comparable countries. By comparable countries, I mean Western democracies, wealthy countries: Britain, France, Canada, Scandinavian countries. We spend roughly double per person what they spend on healthcare. Somewhere approaching $11,000 a head goes to the goes to healthcare in the United States versus about $5,500 in the average of our fellow Western democracies.
0:36:21:57 Dr. Edward Hoffer: So we are spending obscene amounts of money. And we’re not really getting good value for our money. We’re getting, if you look at healthcare outcomes in the U.S. versus our fellow Western democracies, we’re pretty mediocre by most measures, including things like life expectancy. We’re either in the middle or down near the bottom. So we’re spending a lot, and we’re not really getting value for our money.
0:36:52:47 Dr. Edward Hoffer: Why? The best answer was a title of a paper written by Professor Uwe Reinhart, who is now the late Uwe Reinhart, who was a health economist working at Princeton, and he wrote a very famous paper, the title of which was “It’s the Prices Stupid.” Because we don’t use more healthcare in this country. If anything, we—people see doctors less often and are in the hospital for fewer days in the U.S. than they are in than say, France, Britain, Germany, other countries to which we are similar. But what we do – do is we pay a whole lot more for everything we do.
0:37:39:19 Dr. Edward Hoffer: If you look at the cost of medications in the U.S., it’s two and one-half times higher than it is in comparable countries. If you look at the price of a hospital stay, the price of an imaging test, the price of almost everything is 2 – 3 times what it is in the U.S. versus in comparable countries. That is something that has got to be reined in before healthcare simply bankrupts the United States.
0:38:10:41 Dr. Edward Hoffer: If we want to get down to some specifics, one is the very high burden of administrative costs that we pay. I found one study that looked at the cost per person that could be attributed to the administrative costs. Overhead, things like the cost that doctors have to spend to fill out forms to do preauthorization to get tests for their patients, to do so-called quality measure reporting—none of which have helped improve quality.
0:38:43:91 Dr. Edward Hoffer: The administrative overhead of our insurance companies. And in the average and comparable countries, it’s $200 per person per year. And in the U.S., it’s $940 per person per year. So almost five times as much is spent, we’ll say, is wasted on administrative overhead in this country. Paperwork never made anybody feel better. Doctors in this country are drowning in paperwork.
0:39:14:93 Pamela D Wilson: The United States is very different from other countries because we have employer-sponsored health insurance. How and why does this make changing the health insurance system challenging.
0:39:25:57 Dr. Edward Hoffer: We’re not unique, there are other—European countries that do have some degree of employer-sponsored health insurance, but we are unique for the non-Medicare population it is far and away the largest source of people’s insurance. It really is a small historical accident that during World War II, wages were frozen, and the companies that wanted to attract workers couldn’t offer them higher salaries, so they threw in benefits.
0:40:02:83 Dr. Edward Hoffer: And one of the prime ones was health insurance. And so that became a sort of an expected benefit. And when costs were manageable, that was not a bad arrangement. But as healthcare costs have soared, employers have sort of fought back by doing things like raising deductibles, raising co-pays. So that health insurance for many, especially low-paid workers, is becoming less and less valuable.
0:40:39:01 Dr. Edward Hoffer: You know, if you’re somebody who is making a little above minimum wage, and you find that yes, you have health insurance, but it doesn’t kick in until you’ve spent $5,000 what you do is you start cutting back on care. And for a lower-paid employee, having that kind of health insurance is almost as bad as not having any at all. Because what they do is they skip preventative care. They skip required tests. In many cases, they skip medications.
0:41:14:99 Dr. Edward Hoffer: So employer-sponsored care is becoming less and less of a valuable benefit to many people. Those who have good policies—and a number of unions have negotiated real gold plans where everything is covered, and these people love their coverage, and of course, they are not going to want to give it up. You have the fear of the unknown. You know, I’ve got a policy through my employer.
0:41:49:88 Dr. Edward Hoffer: I don’t want to lose it because I’m not sure what’s going to happen. The inertia factor which affects all of us in everyday life. You know—giving up something we have for something we’re not sure we understand. The fact that this is a dominant provider of health insurance makes it hard to change.
0:42:10:73 Pamela D Wilson: And for all of these people who are either uninsured or, like you mention, their income is so low, it doesn’t make sense for them to even have health insurance if they have to spend $5,000 before they get anything. What’s the solution for the uninsured or the people who can’t afford healthcare?
0:42:27:66 Dr. Edward Hoffer: My belief strongly and politically it’s probably a non-starter at the moment is that we should have single-payer universal coverage. Where basic healthcare is provided as a basic human right. And again, to have someone in a country as rich as the United States to have somebody die because they can’t afford proven, effective care is immoral and unacceptable. I don’t think that everybody should necessarily expect identical care.
0:43:02:99 Dr. Edward Hoffer: We are not a socialist country we are a capitalist country. And those who are financially better off can have their elective cosmetic surgery they can have their concierge doctor. They can have their private room when they get hospitalized. And just as they drive fancier cars and live in bigger houses. But I think that proven preventative care, proven therapeutic care should be available as a right to everybody in this country.
0:43:35:93 Dr. Edward Hoffer: I’m also realistic enough to know that that’s not going to get through our current Congress. So more practical approaches could be adopted almost immediately. Would include things like expanding Medicaid. Under the affordable care act, states were given incentives to expand Medicaid. Some did, some didn’t. I think we need to increase the carrots and increase the size of the stick to encourage every state to expand their Medicaid coverage.
0:44:13:62 Dr. Edward Hoffer: I think we should gradually decrease the age of eligibility for Medicare and also probably let smaller companies buy into Medicare. Because it’s often the smaller companies that simply cannot afford and don’t provide healthcare insurance to their companies. And we should make it easier to enroll on the exchanges. You know, at the moment, it’s bureaucratically difficult, and there’s a very steep cutoff in subsidies. I think it should be made easier and more attractive for people to sign up for insurance through the healthcare exchanges.
0:44:54:05 Pamela D Wilson: You and I had talked before. We talked about Medicare capping fees, and a lot of consumers don’t know that Medicare has a cap. So if that was what we ended up doing and we got rid of this scary term that’s Medicare for All, where people are scared of this. Scared because they really don’t know what it means, and we just offered Medicare capped fees for lower-income people. The question is, then how do we pay for that?
0:45:17:02 Dr. Edward Hoffer: There are lots of ways of capping expenses. One, most hospitals will tell you, and I think it’s probably reasonable, is that when they accept Medicare rates. Pretty much every hospital in the country accepts Medicare because you can’t stay in business if you don’t. And their claim is that Medicare covers about 85% of their costs and that they make up the difference by higher charges on commercial insurance.
0:45:54:11 Dr. Edward Hoffer: Well, if they can, if they feel that Medicare covers 85% of their costs, then let’s say that Medicare rates for everybody should be set at, you know, Medicare rates plus 20%. Which would more than cover their costs. It would get away from the fact that you have in many, many places, and this has been repeatedly proven. You have as much as ten-fold variation in the hospital’s charge for the same service.
0:46:31:56 Dr. Edward Hoffer: There’s just no way to explain or to excuse this. It’s got no correlation with quality. It’s pure. It’s the fact that hospitals set whatever rates they want to set. I think there ought to be an upper limit on what hospitals can charge. And it should be set at a fair price. And hospitals can learn to live with it. There’s so much waste in the system. There’s so much bureaucratic overhead that contributes nothing to people’s health that hospitals may have to gradually stop filling a few positions of vice presidents of this, that, and the other thing to get their costs down to a reasonable level. I mean, we have way too many administrators and way too few nurses, and we need to change that balance quite a bit.
0:47:26:99 Pamela D Wilson: But paying for it. So is it—we have social security deductions out of our paychecks. We have Medicare deductions. Is it? Do we have to increase payroll deductions to pay for this for the uninsured? How do we pay for this?
0:47:41:37 Dr. Edward Hoffer: I think there’s some obvious things are to drop the income cap where social security taxes are no longer withheld. You know you make up to your first, I think it’s around $135,000 a year, and if you earn ten times that, you don’t pay any more social security taxes than a person who makes exactly that, and there’s no rhyme or reason for it. It should be extended to your total income. I think that we need to reduce fraud and waste.
0:48:20:38 Dr. Edward Hoffer: You know that is a subject that is difficult to get an absolute handle on for the obvious reasons that you only know about the ones that you catch. But even the ones you catch are in the tens of billions of dollars that goes to totally useless procedures that have been proven to do no good and yet keep being done and keep being paid for. We need to greatly increase our ability to catch fraud, which again wastes enormous amounts of money.
0:48:59:33 Dr. Edward Hoffer: We need to lower the administrative overhead. We need to say to insurers if you are going to ask people to report into you on what they are doing, let’s start with things that you have proof that it helps patient outcome. Too much of what people are asked to report on, at considerable administrative cost, is simply somebody’s idea that well, this sounds sensible. We ought to measure this without absolutely no proof that it improves care. And when people look at all of these measures that hospitals and doctors have to provide, they uniformly find that they have no impact on improving care.
0:49:48:96 Pamela D Wilson: Dr. Hoffer, I thank you so much for joining me today.
0:49:53:18 Dr. Edward Hoffer: I, my pleasure. I think people need to get organized. We need the public to start speaking to counteract the lobbyists, and hopefully, we can incrementally make some change.
0:50:09:90 Pamela D Wilson: This is Pamela D Wilson, caregiving speaker, expert, and advocate on The Caring Generation program for caregivers and aging adults. Whether you are twenty or 100 years old, you’re in exactly the right place to learn about caregiver support programs to help you and your loved ones plan for what’s ahead.
0:47:30:00 Pamela D Wilson: If you’re not sure how to talk to your children about caregiving issues or if you’ve tried to talk to your aging parents, let me start the conversation for you. Share this podcast and over 100 episodes with everyone you know. We’re off to a break. This is Pamela D Wilson on The Caring Generation. Stay with me I’ll be right back.
0:51:21:03 Pamela D Wilson: This is Pamela D Wilson on The Caring Generation. Visit my website pameladwilson.com to read the show transcript to find links to research and caregiver support tips mentioned during this program. Click on the Media Tab in the bar at the top of the page and then The Caring Generation. More articles are in my Caring for Aging Parents Blog and The Caring Generation library. Let’s finish up with tips 6-8 for why older adults can’t get care.
0:51:53:39 Pamela D Wilson: Number six is distrust of the healthcare system and the government. I believe this lack of consumer trust has escalated since COVID began with inconsistent messaging and a lack of factual information. I don’t know about you, but I choose my news sources since most of them—my opinion again— rarely present both sides of the story. Most have the goal of telling consumers how to think, which I can’t entirely agree with.
0:52:25:37 Pamela D Wilson: You have your own mind. Do your research. Find the facts. Understand the consequences. Gather a few opinions, and make the best decision you can—whether it’s about getting vaccinated or placing a parent in an assisted living community or a nursing home. Just remember if things don’t go the way you expect, take responsibility for your decisions and don’t blame others. Next for why older adults can’t get care is reverse bias.
0:52:59:59 Pamela D Wilson: Just as healthcare providers can be biased against providing care for the elderly who may have outlived their usefulness, older adults, persons living in rural communities, and some minorities are less trusting of doctors. Building relationships with the healthcare system takes time. Building trust takes time. If you want to trust a doctor, you will eventually have to establish care with a doctor. Like we talked about with Dr. Edward Hoffer, medical co-pays can prevent getting the care you need.
0:53:37:77 Pamela D Wilson: Find a way to prioritize your health today by setting an annual medical appointment for preventative screenings and treatment. Your older self will thank you years down the road, especially if you were able to catch chronic diseases before they became life-affecting. Number seven for why older adults can’t get care is having a diagnosis of memory loss.
0:54:04:33 Pamela D Wilson: This one is especially challenging because any person with memory loss, unless they have excellent insight, does not realize he or she is experiencing memory loss. It’s difficult to discuss a concern with a physician that you don’t recognize having. On this topic, if someone says you are becoming forgetful, don’t argue with them. Your children or a friend may be trying to help you.
0:54:32:90 Pamela D Wilson: Accept the feedback and make a doctor’s appointment to investigate the issue. There are times when memory loss can be affected by prescription medications, having a urinary tract infection, or other health concerns. It’s best to take a direct path and investigate the causes. If you are diagnosed with memory loss, then it’s time to create a care plan including legal planning so that you have someone to care for you when you can’t.
0:55:02:18 Pamela D Wilson: Memory loss is a major reason why older adults can’t get care. If you can’t make medical or financial decisions and you have not appointed an agent under power of attorney, it will be very difficult to predict who will make healthcare decisions for you. Wouldn’t you rather receive care from someone you know and trust? Number eight for why older adults can’t get care is an obvious one that not everyone considers.
0:55:32:56 Pamela D Wilson: Some adults grew up or have lived their lives in very rural areas where access to doctors, hospitals, and other providers is not nearby. This may not be a big deal when you are young. But when you age and have health issues that benefit from ongoing physician visits—it is a big deal. I know of several individuals who lived in rural areas. They didn’t feel well and died in the car on the way to the hospital.
0:56:04:33 Pamela D Wilson: While I realize that moving from a long-time home may be emotionally difficult, having easy and close access to medical care becomes more important when older. If you are in your 60’s, do you access to medical care. Where does your family live? Have your children moved thousands of miles away? If something happens to you, who is your caregiver?
0:56:30:28 Pamela D Wilson: If you have planned and have answers to all of these questions, you may have a great care situation established to respond to the unexpected. If not, it’s probably time to have that conversation that I recommend all families have before any type of care situation arises. Who will care for you, where will care be provided, and who will pay for care? Rather than reacting in crises to the unexpected, create a plan today.
0:57:02:86 Pamela D Wilson: If you are an aging adult or a caregiver not sure what to do or how to plan for care, my website PamelaDWilson.com offers resources for caregivers. Check out my caregiving library, my Caring for Aging Parents blog, listen to all of The Caring Generation podcasts, read the radio show transcripts, watch videos, check out caregiver courses online, and introduce your parents, siblings, friends, and family members to my YouTube Channel, featuring hundreds of caregiver videos. You can also check out my Facebook page and my online caregiver group there. It’s called The Caregiving Trap. There’s something for everyone at PamelaDWilson.com.
0:57:44:13 Pamela D Wilson: This is Pamela D. Wilson, caregiving expert, advocate, and speaker. I look forward to being with you again soon. God bless you all. Love to everyone. Sleep well tonight. Have a fabulous day tomorrow and pleasant journeys until we are here together again.
0:58:04:03 Announcer: Tune in each week for The Caring Generation with host Pamela D Wilson. Come join the conversation and see how Pamela can provide solutions and peace of mind for everyone here on Pamela D Wilson’s The Caring Generation.
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