Does The Aging Of The Population Really Drive The Demand For Health Care?
(from Concluding Comments)
The objective of this essay has been to deconstruct the popular myth that the aging of the population by itself is a major contributor to the annual increase in the demand for health care and, thus, to total national health spending…the bulk of the rapid annual growth in national spending in the past has been driven by other factors that increase per capita spending for all age groups. Key factors include rising per capita incomes, the availability of promising but costly new medical technology, workforce shortages that can drive up the unit cost of health care, and the asymmetric distribution of market power in health care that gives the supply side of the sector considerable sway over the demand side. These other factors will be the dominant drivers of health spending in the future as well. Blaming Medicare’s future economic pressures mainly on demographic factors beyond policymakers’ control is an evasion of more important challenges. [emphasis added]
Reinhardt, Uwe E. Does The Aging Of The Population Really Drive The Demand For Health Care? Health Affairs, 22, no.6 (2003):27-39.
In 1986, Congress enacted the Emergency Medical Treatment and Active Labor Act, which forced emergency care providers (hospitals) to provide care without reimbursement. Hospitals have only survived by shifting the cost of this uncompensated (and unfunded) care to those with the ability to pay. Oddly enough, Uwe does not mention this “key factor”: an implicit subsidy driving demand. Fortunately, some are starting to take notice, ex. Ezra Klein (see below).
Washington Post: Repeal EMTALA! Jan 27, 2011
Today, I started to wonder whether there are freely accessible statistics on cohabitation. I’d like to be able to confirm a trend I see anecdotally, but I wasn’t able to find much on unmarried couples living together without children/dependents. However, I did come across a wealth of data on “living arrangements” over at the Census (Families and Living Arrangements).
Comparing detail tables (Table A1) from 1999-2010, I created the following chart. It shows, as a percentage of people age 20+ (‘adjusted adults’*); how many people are married and with their spouse or have never been married. These categories exclude those who are married to an absent spouse, widowed, divorced, or separated.
In just 12 years, there was a 3.5% decline in people that are married with their spouse present, and a 3.4% increase in people that have never been married. In that same time, the widowed decreased by 0.55%.
Arguments over who may access state-granted ‘marriage’ benefits (including its titular reference) may be obscuring more foundational changes in how people relate to the origins of the state and its institutions.
*Note: Redefining ‘adjusted adults’ as 18+, the changes are -3.3%, +3.1%, and -0.51%, respectively.
The table below shoes the increase, by age group, in people who have never been married (from 1999 to 2010). The biggest changes are in those aged 45 – 74 years old, who now represent late boomers and early Gen Xers.