HEARING - U.S. Senate Special Committee on Aging

79
been quite a few articles that have said-and I do not know how
they come up with the numbers-but they say that 70 percent of
the health care costs in the United States are because people abuse
their bodies and bring these costs on themselves. So, by getting
people involved in taking care of themselves, you will not have the
health care in the first place.
Chairman MELCHER. Well, I have given up telling my wife it
would be better if she did not smoke, and telling the kids to forget
about so much alcohol.
Mr. SHAPLAND. But there are incentives. I am sort of a nut on
this subject because I feel very strongly that we should have financial
incentives wellness.
Chairman MELCHER. Well, what I am getting at is one of the witnesses
today graphically demonstrated that because her husband
had piled up bills for his health care that she could not handle,
that she was foregoing treatment for her high blood pressure and
some corrective knee surgery.
I do not know what that is going to cost in the long run, but it
might cost a ton of money.
Also, Mrs. Yelineck, for reasons I understand, put off surgery she
needed, which was not wise.
Mr. SHAPLAND. Correct.
Chairman MELCHER. Now, I am not going to ask you to do this,
because I think it is too tough to figure out. But when we remove
those obstacles-in this case, for these two witnesses, just to do
what they ought to do, in a timely way-we are cutting down on
the costs of medicine for them throughout their lives.
Now, obviously, that is a savings, it is an offset. I am not going to
ask you to measure that. I think that is very difficult. The first
one, I do ask you to measure-if at some threshold, each individual
in America would be spending so much for either nursing home or
home health care, what it would cost.
Mr. SHAPLAND. You see, the insurance industry wrestles with
this problem every day and has modernized its coverages-over the
years for this very reason. For example, we ask ourselves if we provide
home health care, isn't that a lot cheaper and better for everybody.
For every dollar one spends on home health care, maybe they
save $10 in nursing home costs.
So to the degree that, say, Medicaid does not cover some of those
things, I think you need to think about expanding Medicaid so that
it does. Penny-wise and pound-foolish is what you are talking
about.
Chairman MELCHER. Yes, that is exactly what I am talking
about. Now, I have asked you for three things-first, this actuarial
advice to us, and then for the critique on the Harvard Medicare
study-and what was the other one of those?
Mr. SHAPLAND. I have down here that you have asked me to provide
you with the new NAIC standards on long-term care; 4 to read
the Harvard report and give you my analysis of that; 5 to give you
a list of the companies and policies that provide long-term care cur-
4See appendix, item 8, p. 155.
5 Ibid., p. 150.