On July 30, 1965 -- 50 years ago -- Medicare became law. But a lot has changed in a half century. It's time to consider how Medicare must evolve to ensure that it maximizes healthy aging and disease prevention.
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On July 30, 1965 -- 50 years ago -- Medicare became law. With the stroke of a pen, President Lyndon B. Johnson transformed the lives of millions of Americans. Today, more than 43 million seniors have health insurance through Medicare and, as a result, are in better health and living longer than ever. But a lot has changed in a half century. It's time to consider how Medicare must evolve to ensure that it maximizes healthy aging and disease prevention.

We now know, for instance, that prevention is effective against most chronic diseases and that it works into the oldest ages. That's especially true of conditions like diabetes and obesity, exploding at epidemic rates. The good news is that prevention saves lives and money. If we fail to focus on prevention, the burden on Medicare -- and on taxpayers -- will become unsustainable as people with these conditions get older. Fortunately, there are strategies that Medicare can adopt to maximize its impact on disease prevention and health creation. One projection shows that joint clinical and population-based investments in preventive strategies save 90 percent more lives and reduce costs by 30 percent after only 10 years. After 25 years, that investment would save 140 percent more lives and lower costs by 62 percent.

Following are the five strategies that I recommend. I have presented them in more detail in an article titled "A Prescription for the Next Fifty Years of Medicare" in the journal Generations.

1) Start at Age 50. We cannot afford to wait until Americans turn 65 to start investing in their future health. Medicare should extend clinical and community-based prevention to cover adults from age 50 on, with the full set of screenings and preventive services, oral health care, vision and hearing examinations, glasses, and hearing aids. Those who arrive at age 70 in good health are likely to remain that way for a long time. Waiting simply increases the financial burden on taxpayers.

2) Prescribe Prevention. Medicare providers should be able to prescribe community-based programs that support physical, mental, and cognitive health, and patients should be able to get reimbursed by Medicare for using these programs. For example, pool exercise makes a great difference for those with arthritis to improve mobility; the "walking school bus," in which older adults exercise on foot by taking children to school; or an AARP Experience Corps-like service through volunteer engagement that addresses the volunteers' health, the academic success of elementary school students, and the broader cause of improved education.

3) Coordinate Care and Prevention Programs. Linking pro-health programs access to Medicare, Medicaid, the Administration on Aging, and the public health system will result in more efficiency and effectiveness in supporting health across our longer lives. As one example, Medicare can partner with local public health departments to link older adults to community prevention programs.

4) Create a Cadre of Geriatric Health Professionals. Currently Medicare helps fund graduate-level medical education for hospital residents. Medicare should expand this support to include medical training in geriatrics and for public health professionals to build up these much needed fields. Such an investment would help fill a gap for health professionals with the know-how to extend care for seniors in and beyond the doctor's office and into the community and home.

5) Coordinate Efforts. Medicare should work with the Centers for Disease Control and Prevention, as well as state and local partners, to track seniors' needs and share information on the effectiveness of specific prevention programs through a central database accessible to everyone, including seniors. Many health-producing community programs are not now financially-covered services of Medicare. As a result, many isolated older adults suffer from inadequately treated chronic conditions and unmet needs, while others develop conditions that could be prevented. Treating individuals for serious preventable conditions too late again results in greater Medicare costs and leaves the individual to suffer unnecessarily.

These five strategies would set Medicare on an expanded course for the next 50 years that would save money by increasing disease prevention and health into the oldest ages. That's a course that taxpayers need to embrace. If not, we will spend more and struggle to maintain the current level Medicare services under growing rates of chronic disease. If we set off in this new direction, Medicare can continue to transform the lives of older Americans just as it did when Lyndon Johnson picked up his pen 50 years ago.

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