Can Preventive Medicine Alleviate the Coming "Boomer Crisis"?

A new report from the Institute of Medicine released this Monday paints a grim picture of healthcare system readiness to accomodate the aging boomer generation (MSNBC has the summary of the details).

The children of the post-war demographic wave, starting around 1945 will begin turning 65 in just a few years. A huge influx of new beneficiaries into the Medicare system is bound to increase demand for care out of proportion to available funding and supply. That is while the looming Medicare budget crisis is bound to put the squeeze on reimbursement rates for providers.

Now, what does this have to do with prevention and wellness?

A real dilemma about allocation of resources that goes beyond dollars-and-cents calculation into the realm of ethics. The challenge with senior care is that as medical technology improves, people's lives prolong and health become even more expensive to maintain. Part of the reason Medicare has been relatively successful up until now was due to the relatively smaller senior population and less extensive supply of costly medical technology.

To quote from MSNBC story:

The study said Medicare may even hinder seniors from getting the best care because of its low reimbursement rates, a focus on treating short-term health problems rather than managing chronic conditions and lack of coverage for preventive services or for health care providers’ time spent collaborating with a patient’s other providers.

As the competition for resources become ever more acute, the ethical dilemma becomes whether the money spent on care some may call "futile" could or should be redirected towards chronic disease management and prevention. While the case for prevention for children and younger adults is pretty straightforward (reducing chance of getting sick before old age), for seniors the question is whether prevention works, does it truly extend life and does it reduce short-term and long-term cost of care.

The thorniest part is in balancing these factors

If a budget squeeze puts prevention and disease management on the chopping block, how much cost would be created through lack of early detection programs? Would this lead to greater mortality, perhaps reducing (or not) the total cost of care? On the other hand if money were to be taken out of acute end-of-life care and put into prevention, would the chance to prevent sickness be worth deteriorating care for those who need it today?

I do not think these are easy question to answer. Statistically speaking this is a multi-variate optimization problem and a lot of research is needed (per risk factor, condition, demographic group, etc) just to understand the numbers. But in the end it is up to humans to make a call based on values.

What do you think should be the right role of prevention in senior care?