The Trustees of the Medicare program recently reported that the Medicare Trust Fund will be insolvent in eight years, much sooner than their projection even a year earlier. By the end of that period the baby boom generation will have begun retiring and receiving Medicare benefits. The combination of rising costs of per capita health care for the elderly combined with the growth of their numbers is especially disturbing. More and more ways are being found to keep the elderly alive longer and longer, often in poor health, and with higher and higher costs. Four leading medical conditions of the elderly underline that trend.

Heart Disease

Heart disease has long been the leading cause of death in the United States. However, for the last 60 years, the age-adjusted mortality rate heart disease has been in decline. From 1950 to the mid-1980s, heart disease has contributed to the overall mortality rate at roughly 40 percent; since 1986 this has slowly decreased. By 2005, the most recent data from the Centers for Disease Control and Prevention (CDC), heart disease accounted for 27.1 percent of overall mortality in the U.S, at an age-adjusted rate of 222 deaths per 100,000 people.

But in stark contrast to the decreasing mortality rate from heart disease, expenditures are on the rise. In 1995, costs for heart disease totaled $75.9 billion, according to the National Center for Health Statistics. Over $55 billion of this was spent on individuals over 65. In 2009, our nation will spend $183 bil-

lion directly on heart disease, according to the American Heart Association, and others are pointing out the increased utilization of interventions for heart disease among the elderly.

For treatment expenditures alone, the Milken Institute has projected an increase from $64.7 billion in 2003 to $186 billion in 2023, a 187 percent increase. Even in its most optimistic scenario, which assumes among other things behavioral changes and decreasing obesity, total treatment expenditures would still grow 70 percent to over $110 billion dollars. While our spending on heart disease may claim as its success a decrease in heart disease related deaths, our expenditures to that end are not stabilizing in the least.

End-Stage Renal Disease (ESRD)

Although end-stage renal disease ranks far lower than heart disease as a cause of death (ninth, according to the CDC), expenditures for its most common and most highly-effective treatment, hemodialysis, are very high and rising dramatically. The most recent data project the number of dialysis and kidney transplant patients to increase by over 150 percent in the next eleven years, which will make it even more difficult to curtail expenditures. Through a legislative move in the mid-1970s, Medicare covers dialysis and kidney transplants for all age groups. In recent years, however, those over age 65 have become the fastest growing group of patients. Of those beginning ESRD therapy, the current adjusted incidence rate is only 2.4 percent for persons aged 45 to 64 years old, while it is 11 percent for patients over 75. Absolute costs for ESRD, for both Medicare and non-Medicare payers, have increased from $8.01 billion in 1996 to $33.61 billion in 2006. Medicare spending for ESRD has increased by an average of 9.2 percent annually from 1992 to 2006. Annual Medicare expenditures for hemodialysis have increased over 400 percent since 1991 to almost $17 billion. Kidney transplant expenditures by Medicare have increased by 342 percent since 1991, and in 2006 they were over $1.8 billion, due to a combination of rising costs for both organ acquisition and the transplants themselves.

Cancer

The cost of treating cancer, the second leading cause of death, rose to $72.1 billion in 2004 from $18.1 billion in 1985. As a share of overall health care spending, however, cancer treatment remained at about 4 percent during that time. But with the U.S. population growing and aging, the total number of cancer cases is expected to increase by 45 percent between 2010 and 2030; 67 percent among those over age 65. This trend will undoubtedly increase the burden on the Medicare system.

At present, lung, prostate, breast, and colorectal cancers are the leading types of newly diagnosed cancers. They account for about 60 percent of all cancers in the elderly and, in 2004, accounted for almost half of total cancer expenditures. While the incidence of colorectal cancer is declining, the National Cancer Institute projects that the cost of treating it will increase by 89 percent between 2000 and 2020. Moreover, another study in Health Economics in 2008 concludes, “costs are more likely to increase at the individual level as new, more advanced, and more expensive treatments are adopted as standards of care.”

Metabolic Syndrome

The Metabolic Syndrome is diagnosed in a person who has at least three of the following five conditions: abnormal glucose levels, low HDL cholesterol, elevated blood pressure, high trygcleride levels, and abnormal obesity. Those with the syndrome have an increased risk of stroke and heart disease. There has been a sharp rise in recent years in treatment of conditions that make up metabolic syndrome. Significantly, “virtually all growth in Medicare spending from 1987 to 2002 can be traced to the 20 percent increase in the share of Medicare patients treated for those conditions during a year,” stated an article in Health Affairs in 2006. Moreover, it continued, “spending may continue to rise as increases in longevity…prolong the period over which they incur high costs year in and year out….mortality reductions resulting from improvement in chronic care may improve health…and increase spending simultaneously.” Two commentators on this trend had a disconcerting observation regarding the effectiveness of treatment for the condition: “ultimately, it will be difficult to distinguish undertreatment from overtreatment.”

Polo Black Golde is a research assistant at The Hastings Center.