My previous column concluded that seniors generally are not more "sickly" than others, but many of their health problems are serious - and they are costly. Why?
Even when treatable, most are not curable. There is no antibiotic for diabetes, macular degeneration, arthritis, Alzheimer's disease and so forth. Antibiotics have created the delusion of inevitable curability. There are no immunizations for any of these, and it is really immunization that has conquered such dreaded diseases as smallpox, typhoid fever, polio and diphtheria, creating today's much healthier world.
Granted, some seniors have been cured of cancer. Through diet, exercise and medication, some have escaped hypertension and diabetes. But mostly, they live with their problems with constant treatments, when such are available - and treatments cost.
Diabetes must be monitored. Blood must be drawn, in some cases multiple times daily. It is just a droplet, but the drawing is not really painless - and the equipment costs. So does the insulin or other medication. Every day, without fail.
Arthritis hurts. It also cripples. Medications that once seemed to promise relief have proved to be dangerous. I have tried supplements, but they were useless. Cortisone often brings relief, particularly when injected, but it is damaging when taken orally over a long period of time. Over-the-counter pain relievers can help, but none should be taken for years, and arthritis does not go away. Every option for relief costs.
Vision is perhaps the most precious of the six senses. While cataract surgery is almost routine and highly successful, glaucoma and macular degeneration can lead to blindness. Daily use of medication to control pressure in the eye often stops glaucoma, but it must be done without fail - and it costs. Medical treatment for macular degeneration is less certain of success - and it costs.
The picture is clear: Many aging people struggle constantly with one or more serious health problems. They are confined within routines of attention to pain and disability and the threat of worse things to come if they are not careful. Whatever they do costs.
These costs are paid out of their own resources or by Medicare, Medicaid, insurance or the generosity of others. Historically, payment involved the doctor and patient. Now, most payments to doctors and hospitals are through third-party payees. Medicare, which is linked to Social Security, is insurance administered by the federal government; so is Social Security itself. Medicaid, medical care for those with low income, is paid by federal and state governments. Medical insurance coverage, purchased by individuals or employers as part of employee benefits, is limited only by how much the buyer is willing to pay.
There are problems with all of these. Providers - physicians, hospitals and so forth - find that some third-party payers are slow to pay. Cash flow can be like syrup on a cold morning. What conditions they will cover and how much they will pay often makes no medical sense. People who have the conditions and their physicians are victims of irrational rules generated by complex organizations. Governmental or private, they just do not seem to be able to function any other way. Strictures on Medicaid payments are so limiting that some providers refuse to see Medicaid patients. Yes, there is fraud throughout the third-party payment system, but the solution is not to limit help for those who need it but is instead to catch the crooks.
Unless a person is extremely wealthy, it is bad to be old and ill. Individually purchased insurance has become so costly that the person needs to have so much money that insurance is unnecessary. Hacking through the jungle of forms, rules and procedures that are required to get treatment is daunting for people already in pain and who may not be quite as sharp as they once were. Worse, the money they are trying to access is theirs; they are entitled to it.
There are other costs to health problems of the aging. One is physical. They hurt - daily, continuously, endlessly. Some become addicted to painkillers, always looking for ways to get more and risking other dangers to their health and well-being. Others just give up hope, except for the hope of death.
One cost is the loss of the part of self that is tied to achievement. This culture values "doing," not "being." What we do is central to what we are. When the AARP magazine publishes stories of exceptional seniors, they are always achievers. Most elders keep on doing things after they retire, but health problems often bring an end to doing.
Another cost is the loss of autonomy. Increasingly, someone else calls the shots. Why do old folks want to stay in their homes that are not equipped for the handicapped, are hard to keep clean and expensive? It's because it is still their home, the place where they are still the boss. Freed from the clock and schedules by retirement, they can do as they please, eating and sleeping whenever it suits them. They fear consignment to nursing homes or assisted living centers, not because they are bad places - though some in fact are - but because in these, life is channeled by schedules for eating, sleeping, bathing and almost everything else. For some, this is too high a cost.
Roger G. Branch Sr. is professor emeritus of sociology at Georgia Southern University and is a retired pastor.