Medicare Part C: Alzheimer's Caregiving
By William K. Summers, MD
© 1999-William K. Summers, MD
I am appreciative of some of the Alzheimer's Association's action plan to confront the Alzheimer's crisis. I see the crisis clearly. Within the next 25 years, the baby boomers will move through the age of risk for Alzheimer's disease. Fourteen million will fade and expire from this illness. In New Mexico, the number of cases will increase 101%. The current 27,000 cases will be 55,000 by 2025. This is a crisis. The solution offered by the Alzheimer's Association, however, falls short of the need. Demanding $100 million for research is predictable. But, currently there are more research dollars in Aging and Dementia than in AIDS.
Focusing on government prescription drug benefits is also predictable. The attack on the pharmaceutical industry has popular appeal--especially when one looks at their medication costs. But, the government becomes the payer of drugs, price fixing of the pharmaceutical industry soon follow. Drug development would slow, then stop, within a decade. Not a good solution.
A better solution is to have the FDA focus entirely on safety and leave the beauty contest of "efficacy" to the market. This would reduce the cost of drug development 80%. How would you like to reduce your prescription costs by 80%??
There is a third prong of the action plan. It vaguely refers to a $125 million Federal caregiver support program. But, the federal government already spends $85 billion on nursing home care. Most of these patients have memory problems. Over $40 billion is spent by the federal government on home health care. How could $125 million make a noticeable effect?? Eighty percent of Alzheimer's patients live in the community. $196 billion is spent each year by the patient and family caregivers to assist the victim of Alzheimer's disease. One in fifteen adult Americans are involved in the care of a dementia case. Actual relief of caregivers could be accomplished by a combination of volunteers and elder daycare centers (EDCs). To accomplish this would require Medicare Part C.
Medicare Part C??? Yes..... Medicare Part C.
Medicare, as it is structured, is interventative, not preventative. Medicare Part A & B will not pay for prevention of a disease, such as heart disease. Medicare will pay for the intensive care and heart transplant after the fact. The exceptions, such as renal dialysis and breast cancer screening require special acts of Congress. It is time for another exception. Call it Medicare Part C. Prevention is generally cheaper than intervention. Oil changes every 3, 000 - 4,000 miles are cheaper than replacing a motor. Funding EDCs for memory-impaired patients three times a week should be the job of Medicare Part C. Visiting nurses and doctors should go to the EDCs. This could substantially reduce the $125 billion spent on interventive dementia care. The illness and death rate of the in-home caregivers could be reduced--a further savings. Finally, perhaps some of the $196-billion-a-year burden that families provide out of their pockets could be reduced.
Isn't it time we give our memory-impaired seniors and their families a break??
- Sternberg S. "Alzheimer's Tidal Wave Feared". USA Today. March 22, 2000, p1A.
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