Listen asshole, if you are going to post your garbage to a French language NG then do it in French and stop acting like an arrogant anglophone white guy. <robertpeffers@aol.com> wrote in message news:6a4e5e00-f3fc-485d-9763-ca81d97d6c0a@b40g2000prf.googlegroups.com... > Marc's testimony to the Senate on population aging and health care > Posted by Marc Lee under fiscal policy, demographics, health care. > December 3rd, 2007 > Comments: none > > I was a testator (if I was a woman I'd be a testatrix!) to the Senate > Special Committee on Aging today, along with national treasure, Bob > Evans, a couple reps from the Canadian Institute on Health > Information, and UNB's Joe Ruggeri. We all pretty much agreed that > aging is not the issue it is made out to be. As Evans says, the > intellectual debate is over, but the notion that we are headed over a > cliff due to the greying of Canada is a zombie that inhabits our > media. > > And as timing would have it, the Fraser Institute for the Economically > Insane just released its 2007 "sky is falling" health care report > today. The conclusion is hardly a shocker: the Fraser finds once again > that public health care is unsustainable. > > Below is my testimony, which is largely based on my recent study for > CCPA. > Testimony to the Senate Special Committee on Aging > December 3, 2007 > > Thanks to the Senate for having me here by videoconference today to > speak to the issue of population aging and the public health care > system. I wrote a report on this issue that was released in September > by the CCPA, and I believe you have copies. > > What I did in the report was to isolate the different cost drivers in > the public health care system. I looked back to 1975 for a historical > overview of how those factors have affected costs, then projected > forward to 2056 based on Statistics Canada's population forecasts and > the average health care inflation rate over the past decade. > > My finding reinforces those of past studies of the issue: Population > aging, in and of itself, is but a small contributor to rising cost > pressures in the health care system. Based on current projections > there is little to suggest a demographic time-bomb about to go off. > > The main cost drivers, in addition to an aging population, are > population growth and health care specific inflation. Put these three > together and one can determine a minimum amount of annual public > spending increase necessary to maintain the existing level of services > while accommodating a larger and older population. > > On this basis, public health care spending must increase by 4.4% per > year in the near term in order to maintain a sustainable level of > services (by the 2030s the rate slows as population pressures ease). > Population aging alone requires about 1% per year in additional public > expenditures. So, while the demographic changes over a quarter-century > due to aging are indeed profound, this change happens relatively > slowly and the associated annual increase is actually less than either > population growth or inflation. > What really matters for sustainability is the share of public health > care spending relative to our GDP. That is, as long as nominal GDP > growth averages 4.4% per year or more, there is no sustainability > problem. If future economic growth rates are consistent with those > over the past decade (average of 5.6%) or two (average of 5.4%), they > will actually lead to public health care expenditures falling as a > share of GDP. > > In my paper I estimate public health care spending relative to GDP for > a few scenarios of nominal GDP growth. Even if GDP growth was to slow > to 4% per year (a level that is well below historical trends) existing > levels of service could be maintained with only a small increase in > health care expenditures relative to GDP over the next three decades. > Public health care expenditures would rise to 8.4% of GDP by 2038, > when they hit their peak. After this, as population pressures ease, > they fall back to 7.6% by 2056. > > One thing I have not mentioned yet but that is essential in thinking > about health care spending is the enrichment or expansion of public > health care services over time. My study tries to distinguish between > annual spending increases required to maintain the same level of > services from additional spending that expands the suite of health > care services available under the public umbrella. > > The issue of enrichment is historically significant. The average > Canadian receives more than one and a half times more health care > services as his or her equivalent three decades ago. So one important > reason why health care spending is higher today is that we provide > more services, including things like long-term care and home care, > more expansive drug coverage, but also new surgical techniques, and > new diagnostic technologies. > > In fact, the real challenge for financing the health care system is > advances in these technologies - the essentially unlimited potential > to expand the realm of the possible. For example, compared to 1990/91, > an 80-year-old in BC today is twice as likely to have a knee > replacement, cataract surgery, or coronary bypass. > Highly technologically-intensive, end-of-life care poses some > particularly challenging ethical dilemmas in cases where quality of > life or health status is not ameliorated despite great cost. In fact, > according to some important studies, it is not so much the rise in > costs as one ages, as it is the expenditures made in one's final year > of life irrespective of age. > > In my modeling, as long as economic growth rates are consistent with > those in the past, if we maintain the current level of public health > care spending to GDP, there is still room left over to accommodate new > technological advances or to expand the system in other ways. But this > is not unlimited, and at some point, if we want more technology, or > expansion of other services, then we will have to pay a greater share > of our income in order to have it. And that means being more rigorous > about the costs and benefits of different technologies through health > technology assessments, as recommended by the Romanow report. > By the numbers, the historical average enrichment rate is just under > 2% per year over the 1975 to 2006 period. In my paper, I find that a > 1% annual enrichment rate would require an increase in public health > care expenditures from 7.4% of GDP in 2006 to a peak of 8.5% by 2038, > but then falling back to 7.7% by 2056. This would, however, enable the > average Canadian to enjoy 63% more health care services by 2056. > To conclude, it is a myth that an aging population will render the > public health care system unsustainable. The good news is that the > challenges facing public health care are not demographic factors > beyond our control, but technological issues that, while profound, are > suitable to a public process that is well within our control. In other > words, like every other policy area, we need to make choices, and to > do that we need a healthy democratic debate. > > http://www.progressive-economics.ca/2007/12/03/marcs-testimony-to-the-senate-on-population-aging-and-health-care/