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Does Healthcare Have an Ageism Problem? · CareTalk: Healthcare. Unfiltered.

• 0:00
  Does American society simply not care about old people?
• 0:04
  That's the argument put forth by elder advocates who cite indifference toward COVID -19 deaths and poor nursing home care to make their point.
• 0:13
  But if we take a step back, maybe it's actually children who are getting short shrift.
• 0:19
  So are baby boomers starting to sow what they reaped with their glorification of youth culture?
• 0:24
  Or is society really not to blame after all?
• 0:35
  Welcome to Care Talk, America's home for incisive debate about healthcare business and policy.
• 0:39
  I'm David Williams from Health Business Group.
• 0:42
  And I'm John Driscoll, the president of Walgreens Health.
• 0:44
  David, why are you attacking, you seem to be attacking the boomers here.
• 0:49
  They are the ones who suffered.
• 0:50
  I mean, where were you coming?
• 0:52
  How do you come out, come at that?
• 0:54
  Boom, boom, John.
• 0:55
  I mean, not all the seniors are old.
• 0:56
  Not all the boomers are old yet, but they're getting there.
• 0:58
  I mean, here's the argument.
• 1:00
  So if you look at what...
• 1:01
  COVID did it, it took a gigantic toll on seniors, about three quarters of the, about 900 ,000 people who died in the U S were seniors.
• 1:09
  And what's happened now is that, okay, COVID sort of over and people are just accepting it as a part of life.
• 1:16
  And so, you know, people aren't masking.
• 1:18
  So that's maybe hurting seniors, even though they're, you know, they're still dying from COVID.
• 1:23
  They're not, seniors aren't getting antiviral therapy.
• 1:26
  They haven't necessarily got the latest COVID shots and there's little progress on.
• 1:30
  care quality in nursing homes.
• 1:31
  So people are saying, hey, we don't care about seniors.
• 1:36
  Well, I mean, to be fair, it took some time for us to actually understand that three quarters of the deaths from COVID that we were all scared of were hitting seniors, that it was disproportionately dangerous for an elderly demographic.
• 1:57
  When we first got into COVID, there was a fear that this could be like the 1918 flu, where it was disproportionately took the lives of 20 and 30 year olds.
• 2:08
  And so I think we were very slow to actually look at the true trends in the data.
• 2:15
  And to some degree, I don't think we've done a very good job of figuring out, well, why did that happen?
• 2:20
  That we've got weaknesses in our nursing home infrastructure that we probably don't protect.
• 2:27
  patients as well on intake.
• 2:29
  I any visit, any ER visit, any ER in a busy hospital system in America that's running at a hundred percent of census, which is a lot where their beds aren't available.
• 2:40
  You're literally keeping people in hallways and even in places like the Brigham David where you are, which is the vaunted Harvard system, they get overwhelmed and you, you, we've lost the discipline of masking.
• 2:53
  We, we came late to it.
• 2:55
  and then I think have dropped it.
• 2:57
  You know, we don't necessarily have a healthcare system that protects our most vulnerable.
• 3:02
  And when it was stressed, it clearly failed.
• 3:05
  But I think to be fair, we were late to figure that out.
• 3:10
  And I don't think we've actually instituted many changes to improve the safety and secure our actual healthcare system from doing more damage than good for, you know, medically vulnerable seniors.
• 3:26
  Yeah, I mean, I remember at the beginning of the pandemic, people were thinking, well, you know, people have been around a long time and maybe they had the flu or something else.
• 3:34
  Maybe they have some immunity, you know, whereas younger people don't.
• 3:37
  So it was almost, there was sort of a thought of, okay, well, maybe the seniors would be, would be safer.
• 3:41
  Now I think it's a bit much for people to, you know, all know the statistics about how much it affected the elderly.
• 3:46
  And then also while masking is definitely helpful, it's a little bit indirect to say, you know, me wearing a mask is going to have an impact on.
• 3:55
  older people, even if I'm not around them that much.
• 3:57
  And I think most people can't be expected to understand what's going on with nursing homes.
• 4:01
  The nursing homes are just trying to get staff to come in.
• 4:05
  So.
• 4:05
  Oh, so you've got excuses for everything today.
• 4:08
  Yeah.
• 4:08
  I mean, nursing homes, we know that nursing home staffing ratios are thin.
• 4:14
  We know that the money that has been invested in nursing homes is much more about the real estate than the health care.
• 4:21
  And that the president has had a really hard time.
• 4:24
  And the healthcare system is at a really hard time enforcing higher standards for housing and caring for our most vulnerable elderly folks.
• 4:33
  And we've lost a generation of elderly folks.
• 4:35
  One of the reasons why I believe life expectancy is flattening is one is obviously deaths of despair, but the other is deaths that sort of are due to our failure to repair the system where we know it's broken.
• 4:50
  We're medically vulnerable seniors, folks over the age of 75.
• 4:53
  are particularly vulnerable.
• 4:56
  So we should repair the despair and I'll grow back my hair.
• 5:01
  You know, John, there are some reasons to think about why.
• 5:03
  OK, let me let me go back on the other side of the argument and I'll stop with the excuses and say, you know, why does this appear to be happening in terms of maybe older people being looked down upon?
• 5:13
  Well, I think there is an argument that the pandemic maybe made prejudice against older adults worse.
• 5:19
  There's some evidence of that.
• 5:20
  There's a lot of ageism in the society.
• 5:22
  And also older people tend to be segregated from the population.
• 5:25
  You know, those people are, you know, we talk about nursing homes, that's by definition, you know, home away from where the family home is.
• 5:32
  And so there are certain factors that, you know, that do lead maybe to the elderly being marginalized.
• 5:38
  I mean, the the way I think the right way to think about it, David, is that American society has always celebrated youth and even your long term care commercials show elderly folks, you know, hopping on a at least on the way out.
• 5:51
  hopping on a surfboard to hit that next wave, not necessarily being clear what happens after and when they return.
• 5:58
  But you make a really interesting point that in a lot of more traditional societies that are typically the blue zones that Dan Buettner talks about, families age together in the same community and people stay together, whether it's in the Asian communities he's looked at, the Italian communities he's looked at.
• 6:18
  I know it's true in terms of Irish villages.
• 6:20
  where there are, that are populace, where folks tend to age in place and with communities and people take care of each other.
• 6:28
  You see your elderly relatives.
• 6:32
  Whereas in the United States, just, I think, and I think part of it's due to just the demographics of a growing society and where people are, you know, don't necessarily work where their families are or end up living where their family, where they grew up.
• 6:46
  And I think all of that plays into an isolation.
• 6:50
  But what's ironic is we actually, as you know, disproportionately spend a lot more money from a healthcare perspective on the elderly as opposed to youth where, frankly, the dollars would go a long way, whether you're talking about, you know, vaccinations or pediatric care or prenatal care.
• 7:08
  And so we're spending money, but not necessarily getting the results we should, which would be a better lifespan as well as healthspan.
• 7:18
  more, you know, better life as well as a longer life.
• 7:21
  One of the reasons that this this article in this argument rubbed me the wrong way was that I think, are you kidding me?
• 7:27
  You know, I'd like the the older people are very well represented in this country.
• 7:32
  So there's the spending side.
• 7:33
  So on health care, as you say, they're probably they're probably the only people represented in leadership.
• 7:39
  Yeah.
• 7:39
  Well, exactly.
• 7:40
  So we have, you know, on the health care side, Medicare, which is heavily, you know, the spending is for almost all for people that are over 65.
• 7:50
  And although it's funded partly by payroll deductions, much of Medicare spending comes out of the general budget.
• 7:55
  There's also social security.
• 7:57
  And then even within Medicaid, which you think about is the program for the lower income, much of the spending there goes to nursing homes.
• 8:07
  That's when nursing home support is and that's for that's for older people.
• 8:10
  Now, as you say, in terms of leadership, you know, our our current and prospective leaders are all up in this age category as well.
• 8:18
  They may be surfing, not into the sunset.
• 8:20
  I mean, this is what we're dealing with.
• 8:22
  So it could be youth culture, but we've got older people running the place.
• 8:25
  You could make the argument, John, and I would go ahead.
• 8:27
  I dare say that it's that you could say instead of saying that society doesn't care about old people, you could say society doesn't care about young people.
• 8:35
  It's only about 10 % of federal spending is actually on children, just as an example.
• 8:40
  Well, no, and 50 % of all births in the United States are on Medicaid.
• 8:45
  And that would indicate that we're not doing a great job at taking care of the next generation or generations that hopefully will take care of you, David.
• 8:54
  I mean, it's crazy that 50 % of all births are in people who can't afford health insurance and are therefore having to rely on the Medicaid system.
• 9:07
  I think that the All of this points to a broader problem, which is that we don't kind of look at our healthcare spending the way we would look at it from a business perspective.
• 9:19
  What's the return we're getting on those investments?
• 9:23
  There's definitely some probably mismatch or a lack of goal setting around like what's our goal in Medicare?
• 9:32
  It should be, I think, to improve quality of life and lifespan for sure.
• 9:39
  but also healthspan, the quality of life.
• 9:41
  And I don't think that that's really, that's not a metric we've used.
• 9:46
  And I think the same thing should be true for spending, healthcare spending on youth, that there are, where are we gonna get the broadest and biggest return on those healthcare dollars?
• 9:58
  And then you look at those against one another and realize that if we don't take care of the young generation, the old generation's gonna suffer.
• 10:05
  because we aren't going to have caregivers.
• 10:07
  We aren't going to have people having enough babies.
• 10:09
  We aren't going to have healthy enough people to actually provide the care that our society is going to need.
• 10:16
  But I think it starts from kind of taking an ROI perspective on it.
• 10:19
  I mean, would you think that would work and that would help?
• 10:23
  Yeah.
• 10:23
  And John, I like your argument about health span and lifespan.
• 10:27
  Let's look at that at the two ends of the spectrum.
• 10:29
  So for older people, We do have Medicare, hospital care, and although the lifespan isn't as long and the health span isn't as long as in some of the other industrial countries, on the other end of the spectrum, the comparisons are much worse.
• 10:43
  So for a few years behind Japan and Northern Europe on lifespan and health span, look at the front end of it and see infant mortality and maternal mortality.
• 10:54
  It's much closer to undeveloped.
• 10:57
  country, a low income country than it is to the peers, not even close.
• 11:01
  So that says something about your argument right there, even if we don't get into the finer points of return on investment.
• 11:08
  And if you just look at the poverty rate, the poverty rate for seniors in 2022 is about 10 .9 % versus 16 .3 % for kids.
• 11:18
  Interestingly, during COVID, John, we actually did see a big difference here and kids were actually taken care of and we showed we could actually do something about child poverty in the near term even.
• 11:29
  Well, it's a great example, David, because during COVID due to basically three reasons, an expansion of the earned income tax credit, which puts money into or allows poor working families to keep more of what they earn, a relaxation of standards for Medicaid, that's the coverage for the poor that pays for healthcare insurance, and a relaxation of standards for food stamps.
• 11:53
  I mean, child poverty dropped dramatically.
• 11:56
  It was 12 and a half percent in 2019.
• 12:00
  And it's kind of offensive to think that nearly 13 % of our kids couldn't afford to get three square meals.
• 12:09
  And in 2021, it was, I think it was down to 5%.
• 12:14
  I mean, that's a dramatic reduction, but it shows you the power.
• 12:19
  of federal and state programs to dramatically change the quality of life for the people that government serves.
• 12:31
  And what that means is when you go from 12.5 % to roughly 5 % is those kids who are no longer in poverty, they're going to have higher IQ scores.
• 12:45
  They are going to be more likely to go to school.
• 12:48
  their health and health long -term health care costs, not just their costs of care when they're young, but their long -term lifetime costs will actually drop.
• 12:58
  It is a very high return investment to lift kids out of poverty.
• 13:04
  It produces more working adults and healthier adults to kind of fuel the economic and social engine of the United States.
• 13:13
  But it's a great example that in a very short period of time, by investing and relaxing, by relaxing standards, including more people in poor communities that we will, I think, dramatically change those kids' life outcomes for the rest of their lives.
• 13:30
  John, you started off the show by asking about baby boomers and whether they should be blamed.
• 13:35
  And now I'm going to go ahead and close up by actually blaming them, laying the blame on them.
• 13:40
  Here's why, John.
• 13:41
  So I think the baby boomers are the ones who really invented the youth culture and, you know, idolization of youth.
• 13:48
  So in some ways it's just like, hey, what, you know, what goes around comes around.
• 13:51
  And then you could actually understand the resentment by younger folks about what the baby boomers have or haven't done on the environment, climate change, the political system, the national debt.
• 14:01
  And, you know, so maybe it's fair to, you know, to pin it on the, on the boomers.
• 14:07
  Well, I don't think you're wrong, David, the boomers, the boomer generation.
• 14:11
  is responsible for generating a lot of debt, the federal government borrowing a ton of money to pay for a lot of programs that may or may not work and not even pay attention to the long -term costs of that compounding debt on the next few generations.
• 14:29
  But based on how they're doing in the Medicare program, they're going to have to pay a lot more attention to the younger generation to fix the flawed system that they've built.
• 14:41
  Well, on that note, John, I'll say that's it for yet another episode of Care Talk.
• 14:44
  We've been talking about the old, the young, and what can be done.
• 14:48
  I'm David Williams, president of Health Business Group.
• 14:50
  And I'm John Driscoll, the president of Walgreens Health.
• 14:52
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