1. Is Prevention Key to Preventing an Aging Tsunami? Is Prevention Key to Preventing an Aging Tsunami?

2. Remarks of William F. Benson Board of Advisors Meeting Center on Global Aging/NCSSS June 12, 2009

3. What I Will Touch Upon Demographics of an Aging Society Demographics of an Aging Society Health Care Expenditures Health Care Expenditures MedicareMedicare Long-Term CareLong-Term Care Political/Policy Implications Political/Policy Implications Prevention Prevention Health Care ReformHealth Care Reform

4. “The Future Ain’t What It Used to Be” (Y. Berra)

5. Percentage of Population Over Age 65 Source: U.S. Census Bureau 20002015 2025 5%-9.9% 10%-14.9%15%-19.9% 20-30%

6. Source: From Baby Boom to Elder Boom: Providing Health Care for an Aging Population Copyright 1996, Watson Wyatt Worldwide. Copyright 1996, Watson Wyatt Worldwide. 0 5 10 15 20251930195019701990201020302050 Year Percentage of Population An Aging Population Percentage of U.S. Population over Age 65

7. Baby Boomers A Baby Boomer turns 50 every 7.5 seconds. In 2006, the first Baby Boomers turned 60. In 2011 the first Baby Boomer will turn 65. People turning 50 today have half of their adult lives ahead of them.

8. Gro Harlem Brundtland, Director-General World Health Organization 1999 Gro Harlem Brundtland, Director-General World Health Organization 1999 “Population ageing is first and foremost a success story for public health policies as well as social and economic development.”

9. Demographic Impact on Aging Policy “In general, the aging of the baby boom generation will lead to a sharp growth in federal entitlement spending that, absent meaningful reforms, will represent an unsustainable burden on future generations.” (GAO-05-564T) “In general, the aging of the baby boom generation will lead to a sharp growth in federal entitlement spending that, absent meaningful reforms, will represent an unsustainable burden on future generations.” (GAO-05-564T)

10. Demographic Impact on Aging Policy “The population’s aging will also cause a decline in the share of the population who are of working age – and who pay the bulk of the taxes that support public programs for the elderly.” Source: CBO (Financing Long-Term Care for the Elderly, A CBO Paper, April 2004)

11. The Atlanta Journal-Constitution Tuesday, May 15, 2001

12. “Retiree benefits grow into 'monster' Taxpayer burden: $510,678 a family” USA Today May 25, 2006

13. Health Care Expenditures 2007 Total Expenditures (2007) -- $2.3 trillion Private – 53%Public -- $47% By 2016 Public expenditures will be 50.4% Medicare -- $442 billion Medicaid -- $349 billion Source: The Washington Post – “In Search of Health-Care Reform June 9, 2009

14. Medicare & Social Security Board of Trustees Report – March 26, 2008 Medicare's Hospital Trust Fund Will Be Insolvent by 2019, According to Trustees Report Medicare outlays will exceed income by 2010. The long-term deficit for the program equals 3.54% of taxable payrolls, and fixing funding for the program over the next 75 years would require an increase in the Medicare payroll tax from 2.9% to 6.4% or a 51% reduction in payments to hospitals, nursing homes and home health care.

15. Medicare & Social Security Board of Trustees Report – May 12, 2009 Medicare's Hospital Trust Fund (Part A) Will Be Insolvent by 2017, According to Trustees Report Significant growth in the number of people eligible for Medicare – aging “baby boomers” Increase in prices as a result of higher wages for health care professionals and inflation Individuals requiring more services (utilization) as well as more complex services (intensity)

16. Health Care Expenditures for Chronic Conditions 83% of all Health Care Spending Involved People with Chronic Conditions in 2001 – –Medicare – 98% – –Medicaid – 83% – –Privately Insured – 74% – –Uninsured – 72% Source: Medical Expenditure Panel Survey, 2001, and Partnership for Solutions

17. Long-Term Care Policy-makers focus a great deal on Medicaid especially Medicaid LTC Policy-makers focus a great deal on Medicaid especially Medicaid LTC “Financing the increasing demand for long-term care services will be a significant 21st century challenge for the nation.” (GAO-05-564T) “Financing the increasing demand for long-term care services will be a significant 21st century challenge for the nation.” (GAO-05-564T)

18. LTC Expenditures: A Lot Now & Much More in the Future In 1999, CBO projected that total LTC expenditures for seniors (including government and private spending but not the value of donated care) would rise from about $123 billion in 2000 to $346 billion by 2040. That estimate of a relatively modest increase in spending incorporated the assumption that the prevalence of impairment would decline at a rate of about 1.1 percent per year. CBO 2004

20. LTC = Possibly Much More $$ If impairment levels instead remain about the same as they are today, expenditures will rise faster, to $484 billion by 2040, or about 2.0 percent of GDP. Spending could be even higher if, as some researchers believe, the prevalence of impairment actually increases in the future. Another factor that could translate into higher spending levels is that the cost of LTC care is likely to increase at a faster rate than that of general price inflation since historically, the growth of health care costs has outpaced that of the economy in general. CBO 2004

21. Threats to Health Among Seniors 73% age 65 - 74 report no regular physical activity 81% age 75+ report no regular physical activity 61% - unhealthy weight ~35% - fall each year 20% - clinically significant depression; age group at highest risk for suicide Sources: State of Aging and Health, 2007; www.cdc.gov/nchs; www.cdc.gov/ncipc/olderadults.htm

22. What’s the health picture for Boomers? By 2030 More than 6 of every 10 will be managing more than one chronic condition 14 million (1 out of 4) will be living with diabetes >21 million (1 out of 3) will be considered obese – Their health care will cost Medicare 34% more than others 26 million (1 out of 2) will have arthritis –Knee replacement surgeries will increase 800% by 2030 “When I’m 64: How Boomers Will Change Health Care ”, American Hospital Association, May 2007

27. Diabetes Trends Among U.S. Adults, BRFSS 1990, 1996, and 2003 19901996 2003 No Data 10%

28. Indicator 28 – Use of Time

29. A Few Words About Prevention

30. Exercise Prevention

33. Federal Policy & Prevention –Medicare covers good prevention services, but there’s little promotion –Federal agencies (CDC, AHRQ, AoA) promote evidence-based interventions (note ARC) Older Americans Act – only dedicated funding for HP/DP for elderly CDC’s Healthy Aging Program –Economic Stimulus legislation provides $1 billion for new Prevention & Wellness fund

34. Prevention & Health Care Reform Senate HELP Bill (Kennedy) Mark up – June 16Mark up – June 16 National Prevention, Health, Promotion & Public Health Council National Prevention, Health, Promotion & Public Health Council National Prevention & Health Promotion Strategy National Prevention & Health Promotion Strategy Prevention & Public Health Investment Fund -- $10 billlion per year above FY 2008 levels Prevention & Public Health Investment Fund -- $10 billlion per year above FY 2008 levels

35. Prevention & Health Care Reform Senate HELP Bill (Kennedy) – continued “Independent” Preventive Services Task Force for CPS “Independent” Preventive Services Task Force for CPS “Independent” Community Prevention Services Task Force for community preventive interventions “Independent” Community Prevention Services Task Force for community preventive interventions Community Transformation Grants Community Transformation Grants Healthy Aging, Living Well pilot project for 55-64 population Healthy Aging, Living Well pilot project for 55-64 population Research re E-B practices (esp. for HP 2020) Research re E-B practices (esp. for HP 2020)

36. Prevention & Health Care Reform June 8 letter from 236 organizations to Kennedy & Enzi (HELP) and Baucus & Grassley (Finance) June 8 letter from 236 organizations to Kennedy & Enzi (HELP) and Baucus & Grassley (Finance) Calls for Calls for National Prevention StrategyNational Prevention Strategy Public Health & Wellness Trust FundPublic Health & Wellness Trust Fund Trust for America’s Health & RWJF public opinion survey – Americans rank prevention as the most important HCR priority & overwhelmingly support increased funding for prevention to reduce disease & keep people healthy Trust for America’s Health & RWJF public opinion survey – Americans rank prevention as the most important HCR priority & overwhelmingly support increased funding for prevention to reduce disease & keep people healthy

37. Evidence-Based & Promising Possibilities - SPARC Model for CPS - Green Gym®

38. Thank you! Thank you!