Health Beyond 50: Ouch!
By: Source: AARP Bulletin Today Date Posted: 2003-08-01 15:28:52
Americans are living longer than ever before, but health security is beyond the reach of many people age 50 and older, says an ambitious and comprehensive look at the nation's health system by AARP.
At age 50 Americans can look forward to another 30 years of life, almost nine years longer than life expectancy in 1900, thanks to technology, more sophisticated health care and greater use of vaccines, screening tests and other available health services, according to "Beyond 50: A Report to the Nation on Trends in Health Security."
But many older Americans are not getting the insurance coverage—and the care—they need.
The report consolidates an array of information from the federal government, private polling companies, AARP and other research organizations. It's the second in a series of AARP reports examining the status and progress of older Americans in areas such as economic security and long-term care.
"We hope the report will buttress AARP's advocacy efforts to improve the nation's health delivery system," says Theresa Varner, director of AARP's Public Policy Institute, which wrote the report.
Some of the report's findings bring welcome news. Far fewer older Americans smoke, for example, and the incidence of heart disease and stroke has declined.
| Chart by Wayne Vincent |
| Obesity is defined as excessive amounts of fat in relation to lean body mass. A person 6 feet tall weighing more than 221 pounds is considered obese (and overweight at 180 pounds); someone 5 feet 5 inches weighing 180 pounds or more is obese (and overweight at 150). |
"But our health gains could be so much greater if we ate healthier foods and exercised more," says John Rother, AARP's policy director. "The bad news is that we're in worse physical shape. More of us are obese. That's a danger now and for the future."
While smoking among older Americans decreased 30 percent over the past 20 years, the rate of obesity for those 50 and older nearly doubled during the same time period, possibly limiting positive health gains achieved during those two decades and raising the risk of serious conditions like diabetes and certain cancers.
HEALTH INSURANCE OFTEN UNAFFORDABLE, INADEQUATE
Good physical health is just one measure of health security or well-being. Other indicators are adequate health and long-term care insurance coverage; access to quality health care; protection against financially devastating health costs; and sufficient information for making sound health decisions.
Based on those factors, the report concludes that many Americans 50 and older don't enjoy health security now and are unlikely to in the future. More older people are at risk for being uninsured or underinsured.
Individual health care costs are rising, partly because of the high cost of prescription drugs. After adjusting for inflation, out-of-pocket spending on drugs increased 150 percent from 1977 to 1996.
Getting The Report
For a copy of "Beyond 50: A Report to the Nation on Trends in Health Security," write to AARP Fulfillment, EE01526, 601 E St. NW, Washington DC 20049. Please indicate stock no. D17682.
You also can download the report or order a print copy of it online at www.aarp.org/beyond50.
"Part of the bad news is that the system still is failing a lot of people," says Susan Raetzman, associate director of the AARP Public Policy Institute's health team. She points to huge discrepancies in coverage and access to care between minorities and nonminorities age 50 and older. One in three Hispanics is uninsured, compared with one in five African Americans and one in 10 whites.
Gaps in Medicare coverage, Raetzman says, prompt most beneficiaries to seek supplemental insurance. But the private medigap insurance some people depend on to help cover prescription drugs or other costs Medicare doesn't pay for is becoming more expensive.
Those who retire before they're eligible for Medicare at 65 find that fewer employers are offering health coverage to early retirees, the report says. From 1993 to 2000, the number of employers with 500 or more employees who offered health benefits to early retirees dropped from 46 to 31 percent.
Individual private insurance also covers a smaller portion of people in the 50-to-64 age bracket than a decade ago. And the insurance that is available is often unaffordable.
Because health risks increase with age, people in their 50s and 60s often have to pay high private insurance premiums. One in five adults ages 50 to 64 says their cost for premiums, whether individually purchased or employer-sponsored, is at least $2,000 a year.
Meanwhile, health care costs continue to climb. Between 1977 and 1996, the average total spending per person age 50 and older soared 310 percent to $3,881, nearly twice the general inflation rate.
Making health insurance more affordable and available to older people will take a concerted effort. Rother says policy options include offering certain deductions or tax credits to people who buy insurance, coupled with reforms that would prohibit insurers from rejecting those with certain medical problems. Another would be allowing people to buy into Medicare before age 65.
Substantial changes in private and public financing are needed to make health insurance available and affordable for 50- to 64-year-olds, says Marilyn Moon, senior fellow at the Urban Institute, a think tank in Washington.
"If you're employed, you need to pay close attention to the health insurance your employer offers while you're working and once you retire," she advises. "Don't just assume you'll be covered. Workers must be aware of their benefits and try to maximize them for as long as possible."
Getting The Report
For a copy of "Beyond 50: A Report to the Nation on Trends in Health Security," write to AARP Fulfillment, EE01526, 601 E St. NW, Washington DC 20049. Please indicate stock no. D17682.
You also can download the report or order a print copy of it online at www.aarp.org/beyond50.
MISPERCEPTIONS HAMPER CONSUMERS' HEALTH CARE
Misunderstandings about insurance coverage and the health care system can leave consumers with huge, unexpected medical bills. The AARP report says that 15 percent of people age 50 and older believe, for example, that Medicare pays for nursing home care (it doesn't, except partially for 100 days of care after a hospital stay).
Consumers also have misconceptions about the quality of their care. Despite expert studies exposing deficiencies in quality, people age 50 and older report they are quite satisfied with their own care. As long as disparities between reality and public perception persist, experts say health system improvements will be hard to achieve.
Low health "literacy" may account in part for the disconnect in public perceptions, according to the report, which calls for better health information that's easier for consumers to find and use.
"We need to present health information in a way that will be meaningful to consumers," says Varner of AARP's Public Policy Institute. "Overcoming cultural and language barriers is among the challenges the health system faces in educating people."
CAN THE HEALTH SYSTEM DELIVER IN THE FUTURE?
Looking at past 20-year trends identified in the report, what can older Americans expect from the health care system in the future?
According to Rother, it's a mixed bag. On the upside is the possibility of living healthier longer, with new medical technologies to support and promote that goal.
The downside: It's likely to cost a lot more, with a health system that's even more complex than it is now.
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