FACULTY SYMPOSIUM

Covering Care for an Aging Population

On June 4, a day when both The Boston Globe and The New York Times ran stories about people struggling to face rising healthcare costs during the current economic downturn, the Alumni Week Faculty Symposium focused, aptly, on healthcare policy.

As the auditorium filled, George Thibault, ’69, welcomed the crowd and introduced moderator Barbara McNeil, the Ridley Watts professor and chair of Health Care Policy, an HMS department founded 21 years ago.

Photo by Jan Reiss

At the Alumni Week Faculty Symposium, Health Care Policy faculty members (from left) Barbara McNeil, Michael Chernew, J. Michael McWilliams, David Stevenson, and Sharon Lise-Normand fielded overtime questions from concerned alumni after presenting their thoughts on how to improve the dire state of U.S. healthcare.

The topics the Health Care Policy faculty selected to discuss—the uninsured, the aging population, the high cost of healthcare, and the effectiveness of care—are all timely and, in some cases, dire.

The number of uninsured adults ages 18 to 64 in the United States increased 23 percent from 2000 to 2007, according to speaker and assistant professor J. Michael McWilliams. Predictions put the 2010 number up from 46 million in 2007 to 52 million.

McWilliams zoomed in on the fastest growing segment of the uninsured population: people age 50 to 64. Universal Medicare coverage after 65 improves health outcomes for the previously uninsured, he said, so earlier coverage should benefit this group. Though expensive up front, the costs of universal coverage for this population might be partially recouped later on. Uninsured people often delay care, and, in turn, incur higher healthcare costs once they become insured.

While the uninsured feature prominently in reform talks, few are talking about long-term care for our aging population, according to assistant professor David Stevenson, even though seven out of 10 people will eventually need such care. “Most families will need it,” he said. And it will cost them. Fewer than 10 percent of people carry long-term care insurance and nursing home costs average $70,000 per year. “There are no easy answers,” he said. “But long-term care should be part of the policy discussion.”

Not only are the questions tough, but the stakes are high. “The system will implode—the economy will implode—if we can’t control healthcare spending,” said professor Michael Chernew, who pointed out that while health insurance premiums were up 119 percent between 1999 and 2008, wages rose by only 34 percent.

Chernew introduced a concept called value-based insurance design, which aims to reduce the cost of high-value healthcare—for instance, by making blood pressure medication, which reduces the risk of heart damage, more affordable. Such a program might be good news for people who, as The New York Times reported that day, are filling only the prescriptions they can afford.

Determining what, exactly, counts as high-value care is difficult to assess. Even simply assessing safe and effective care is challenging, according to professor Sharon-Lise Normand, the final speaker. Normand analyzed two treatments for which controversial safety results have been published: rosiglitazone and drug-eluting stents. According to her statistical analyses, these treatments are not as unsafe as reported, yet doctors and regulatory boards are basing medical decisions on these faulty reports.

Ultimately, healthcare policy is all about ­decision-making and designing systems that encourage the most appropriate and most effective care. This message hit home for the alums in the audience who, during the coffee break, became embroiled in shared stories of caring for themselves and their own families. When the session closed, the auditorium full of doctors felt more like a room full of concerned citizens.

—Elizabeth Dougherty

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