[ExI] Longevity Dividend -boomer health care socio-economic policy @ NDP convention

[Morris Johnson]

Just returned from the 2007 Saskatchewan New Democratic Convention.

First public chance to begin elicit discussion of the Longevity Dividend.
The IEET course is to prepare us to discuss this with media and policy
makers.
I ran for election in 2007.  We were government for 16 years then became
opposition with 18/58 seats.

This convention was attended by 550 people:  members of the legislative
assembly, party executive and staff, media and constituency councillors (of
which I am one) and members at large.

One half day was a series of policy and concerns breakout sessions.
We were free to start discussions on any subject related to concerns or
specific policy.
Of the 60 ideas I set out one.
The facilitators termed it "Boomer Health Care  Socio-Economic Policy".
My actual header on the flip chart  was:

"The Longevity Dividend".. How enhanced medical technologies will effect the
boomers"
health care, pensions and work options if the healthy lifespan more closely
approaches full lifespan.

The topics were spread through several assembly rooms and delegates could
move freely from session to session and contribute or observe as they saw
fit.

We had several permanent and a few transient participants.
We first discussed the header to ensure that the topic was clear.
We had the former health minister among the participants.

One reaction to longer average lifespan to date is the shift from defined
benefit to defined contribution pension plans.
It was felt that people could contribute both paid and unpaid work to the
economy as well as ideas well  past their 70's.

Healthy elderly were termed a positive thing.

The question was posed...what to do when deferred savings for projected 20
or 30 year payouts would have to finance perhaps 50 years of pension.
As pension plans become insolvent what happens.. does government reduce the
benefits in anticipation or wait and see what the electorate directs.

It was felt that voters would have to be educated that pensions are only a
part of a retirement plan and that government  might not have to be
responsible to fund shortfalls....other solutions would have to be found.

The Saskatchewan pharmacare program when planned was not fundable for a
birth to death coverage so the advice was to fund only persons over 65.
This rationed services to match the funding to be provided.

It was stated that the last 6 months of life are the most costly for public
funders.
It was questioned if the funding made avaliable to various health services
is
designed to follow the pay-in curve (those likely to live long enough and
well enough to repay by future taxation would have the easiest access).
Would this mean that others would be somehow excluded for services and
groups for whom the prospects for cost recovery through things like future
taxation were poor would be also excluded..

Participants were informed that this can go to great extremes.  The example
of Oregon's ranks procedures and criteria 1-well over 613 but only pays for
1-613.
If your criteria put you in the over 613 group then you will pay yourself or
be allowed to die of natural causes.

We in Saskatchewan have Health Quality Council.  MD's identify high risk
diabetes and cardiovascular disease risk persons and sask health  works to
fund MD's to use
certain preventative diagnosis, medication and procedures.
We were told that 5 million was added to fund this program.
Unasked question was...just how many people would it take to max out the
funding for this risk assessment plus.
The saskatchewan medical association agreed to allow funding  a certain
number of patients.

My "HACCP For Humans" term was agreed to be the sort of wording to summarize
the concept.

The health minister said "it's not expensive to do preventative medicine".

I have seen the QALY calculations for such things as modest cost HPV
screening  come up with very high QALY costing because the
formula multiplies  the cost by the number of procedures required  before a
single death is prevented on a population basis.

I don't think the paricipants were aware of  the exact way the math works,
but time did not permit going into this.

Government often likes to advertise preventative medicine but the media
beats them up based on the cost of the individual adds and ignores the
proposed savings to medicare which is the intended result.

Electronic Health records were proposed to help increase the effectiveness
of preventative medicine but are not fully in place.  Insurance corporations
agree and will do the management for a percentage of the cost savings the
system realizes .  30% was mentioned.

I mentioned that individual health decisions are increasingly forbidden by
law and regulation  by health canada..  I posed the question as to who
should be given final say as to what an individual coulsd or could not
access by thermselves.

Conversation moved to the cost of technology.

I asked.. at what age do you cut off access or do you use biomarkers
instead.
Answer wes "in saskatchewan we try to accomodate everybody".

It was stated that pension funds are the largest shareholders of many large
corporations, pharmaceutical companies and medical device corporatiopns.
These relationships ask for 20$ return and at times are part of a closed
loop of cash flow.

How do public plans deal with provisioning when some products are in loops
their taxpayers are in and some are ones where the profits go outside the
province.
"saskatchewan has a base plan".

This question needed more discussion.

It was related that some areas of saskatchewan had something like a health
plan 15 years before medicare.
Some participants seemed to relate more to older therapies so someone
mentioned
"new technology is endless and the costs are exponential"

Avastin was mentioned.  This is rationed to 80 of 250 colon cancer patients
based on criteria.

Are there better alternatives to make access fully universal.

It was mentioned that some patients have better relatives , doctors or are
better to lobby for access and get it.   Everybody might agree to some
rationing, except if it applies to them or their loved ones.

How does medicare deal with forcing the rationing of things not in the
system such as alternative medicines.

Regulators use the force of law to ration acces but is this ethical.


We were limited by time and rules of order..no interruptions etc.

Morris.

















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