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America’s Elderly and Health Care Administration – Taking Care of the Silent Generation

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Robert Brescia
Jan. 20, 2017

silentgenerationAmerica’s elderly constitute a large group of medical product and service customers. They need much higher levels of care and they need those levels delivered routinely and consistently. As our population continues to age, we should convene committees and groups to assess the elderly’s care needs and find innovative ways to satisfy those needs. This must be a joint effort between the federal government and the states. That’s nothing new—Medicaid is a program administered by both the federal government and the states together. Medicaid was expanded under the Affordable Care Act (ACA) to encompass people with incomes up to 133 percent of the poverty line, including adults without dependent children (states have the option to accept or reject the Medicaid expansion). Seniors benefit from Medicaid as well—although not in a managed care mode generally. Most elderly remain in the traditional “fee for service” (FFS) Medicaid model.

Perhaps we should look at revising the FFS health care delivery method for the elderly. Although the FFS model is the predominant health care administrative arrangement in the United States, it is criticized for incentivizing doctors to schedule more visits for patients because doing so maximizes their revenues. On the other side of the coin, managed service models are lambasted for lack of quality control and the refusal of pre-existing health conditions. Add to that a lack of coherence in price controls by medical providers. This is causing somewhat of a ball of confusion with the insurance companies contracting departments. Hospitals charge for procedures not by real costs to provide but by an artificial fee schedule that the insurance companies use.

Sliding Scales

Another area the government, both state and federal, could consider is proposing and adopting systems that take into account patient age with respect to co-pays and deductibles. I recently listened to a story about a Texas elderly person insured under the ACA with more than $3,000 deductible and high co-pays. Who among us can afford those expenditures? At the very highest level, the ACA counted on a large group of young people signing up for health care. Those premiums could then be used to offset the cost of providing health care to seniors. That didn’t happen and it wreaked havoc with the model.

America’s elderly use more medical services than any other group—but generally they have the least means to pay for those services out-of-pocket. Therefore, the elderly should become the most subsidized of any population group. The young should take heart and rejoice in these recommendations as well, knowing how well they will be taken care of in later life.

Other Helpful Measures

Almost 40 percent of Americans are now providing some type of at-home medical care for an aging family member. This will increase as the baby boomers approach the fall and winter of their lives. If the economy also goes from bad to worse, it could create many more caregivers throughout the nation. The government should provide some type of incentive to these younger family care-givers because what they do is probably less expensive and more effective than what the system can provide. By the same token, we can control health care costs by beefing up tort reform and significantly decreasing the number and dollar amount of lawsuits against medical providers.

Drugstores that deliver prescriptions could be very useful to the aged—I know my Mom gets her prescriptions and other merchandise delivered by a local Walgreens. How about an optional, affordable public home care assistance under a managed care model with coverage for pre-existing conditions? After all, it’s often hard for an elderly patient to displace to the doctor’s office. What about offering optional government-matched health savings accounts where contributions can grow as investments? Consider offering tax advantages to those taxpayers that contribute into their parents’ health savings accounts. How about the government partially subsidizing the medical school costs for those students who agree to an initial 5-year stint as an “in-home, elderly care specialist”? This could also include producing a crop of doctors who specialize in providing care for our military veterans who are now seniors.


I am not a medical expert and there is no Constitutional basis for these ideas—but there is a need for leadership in fashioning solutions for Silent Generation medical care. In my mind, that points to a public-private partnership model. The field of ideas to improve both the cost and the quality of elderly health care is limitless—and the public sector can exercise a leadership role in developing these ideas.

Our aging parents and citizens can live a full life with all of its seasons. We need to get creative about elderly health care and the public sector can lead by spearheading initiatives that legislators could review and fine-tune. The elderly can help by telling their elected representatives what will work best for them. They need a seat at the table and an active voice in fashioning solutions for themselves.

Bob Brescia serves as the Executive Director of the John Ben Shepperd Public Leadership Institute, Odessa, TX. His latest book is Destination Greatness – Creating a New Americanism. Bob has a doctoral degree with distinction in Executive Leadership from The George Washington University. He also serves as Chairman of the Board of Basin PBS – West Texas public television. Please contact him at [email protected] or Twitter: @Robert_Brescia.

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