Some contrarian thinkers say that, rather than swamping and ultimately sinking the healthcare system, aging Baby Boomers have what it takes to reframe, refigure and redefine it. The root cause of the health care crisis can largely be pinned on the impossible complexity of the system. In particular, people with chronic illness must negotiate a thorny maze to get and pay for good care. Within an environment of such complexity Healthwise, a Boise-based health information technology not-for-profit, says giving Boomers more control is the only way to return sustainability to the system. Healthwise proposes solutions that draw on three classic Boomer character traits: self-reliance, resourcefulness, and independence. The game plan breaks out as follows:
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1. Help people do as much for themselves as they can. The self-care rule.
2. Help people ask for the health care that they need. The guidelines rule.
3. Help people say “no” to care they don’t need. The veto rule.
Let’s take these one at a time. Rule #1 is the Self-Care Rule. Boomers are the least deferential, most self-reliant generation in history. If Boomers can be their own travel agents, stockbrokers, bankers, librarians, and grocery clerks, edit their own movies and create their own Web sites, they can do more with their own health care
Boomers are already using the Internet to provide their own self-care or to prepare for doctor visits. Formalizing this ad hoc process through standardized tools and resources will help Boomers help themselves, and greatly reduce costs. To support the nursing and administrative overhead of a primary care office, clinicians must bill for their time at a rate of $200/hour or more, as well as generate revenue from prescribing tests and treatments. In the face of the healthcare staffing and cost crises, it just doesn’t make sense to use a $200/hour resource to do a $10/hour job, particularly when informed and supported patients can do the job just as well—or better—themselves.
Rule #2: helping Boomers ask for the care they need. Boomers are terrible patients, as many doctors will tell you. “They think they know everything because they looked it up online – they come into my office waving pages from the Internet,” groused one clinician.
Fine. Let’s put that resourcefulness to good use. Every year the base of good, evidence-based guidelines for clinical conditions becomes richer and more in-depth. Yet far too often these guidelines are ignored by doctors too busy to keep up to date. For the guidelines to have greater influence, Healthwise says we need to give them to patients too. That way, patients and their doctors can at least discuss the guidelines’ relevance. Any article on health care is likely to preach how important it is for health care consumers to make informed decisions. But people can make informed decisions only when they know the guidelines and understand how well a particular treatment has worked for others. Of course most guidelines are written in medical terms and with a level of complexity that makes them inaccessible for many consumers. That can change. Rewriting guidelines in plain English and prescribing them to patients when they are directly relevant to their medical situation should be a priority for professional associations who create the guidelines – the American Heart Association, for example. Once patients know what the guidelines suggest, they can work together with their doctors to decide on the right course of treatment.
Rule #3 : Help people say “no” to care they don’t need.
An enormous amount of unneeded health care spending could be avoided if people were given the confidence and opportunity to decline the tests, drugs, and procedures
that add little or no value to their health. Boomers are likely to demand better information about what is in their best interests, and the ultimate autonomy to say “no.”
Three areas drive the most costs: testing, surgery, and end-of-life decision making. Physicians and hospitals do a great deal of testing to reduce the risk of a malpractice claim, not always because good medicine requires it. With good information, patients can decline unnecessary tests. Supply-induced demand is a huge factor in driving up the cost of care. Surgeons do a great many surgeries because they are very good at doing them, not always because the evidence shows that they will help a particular patient. With good information, people can say “no” to some surgeries when other options are also viable. Providers give a great deal of care at the end of life to extend life rather than improve it. With good information, patients and their advocates can regain control of those final weeks.
Will Baby Boomers reinvent healthcare to better fit their identity and attitude? For the generation that adopted denim as both a cultural statement and a daily uniform, it is instructive to note that Boomers came up with “relaxed fit denim” when it came time to accommodate their aging physiques. This ability to adapt and reinvent may be the Boomers’ greatest strength. In other words, I wouldn’t bet against them.
Lauren Letellier