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Kai Ryssdal: That SCHIP program John and I were talking about covers children, as we mentioned. At the other end of the health care age spectrum is Medicare.
With more baby boomers approaching the age where they'll qualify for coverage, analysts and politicians are wondering how we'll pay for them. And where we'll get the trained doctors to look after them. From the Marketplace Health Desk at WGBH in Boston, Helen Palmer has more.
Helen Palmer: There are 35 million seniors in the U.S. today. There'll be twice as many by 2050, and there'll be only one geriatrician for every 10,000 people over 75.
Sharon Levine's training the next generation of geriatricians at Boston University. But Levine says only 4 percent of newly-minted U.S. physicians choose geriatrics.
Sharon Levine: Family physicians and general internists make much more money in the private sector than geriatricians do — even though geriatricians are fellowship-trained.
She pulls out a list of pay scales. Geriatricians earn about $160,000 a year. Gastro-enterologists, by comparison, make nearly $369,000. If you were a young doctor leaving medical school with $200,000 worth of debt, which would you choose?
Some do choose to work with older patients though.
Dr. Foy White-Chu: Hi, I'm Dr. White-Chu . . .
Foy White-Chu is checking on 98-year-old Ginger Feder, whose leg's bleeding.
Dr. White-Chu: So what happened here?
Ginger Feder: I scraped it on the bed. I must have lost a pint of blood.
Feder lives in a Boston nursing home, Hebrew Rehabilitation Center, where White-Chu's getting hands-on experience.
Dr. White-Chu: Geriatrics is perfect, because you get the most complex cases. And you don't necessarily fix something, but you can make life better.
Florence Bellis: Only thing I would like to do now is one thing: stand up.
Ninety-two-year-old Florence Bellis is in a wheelchair since a stroke four years ago. Rob Schreiber's her doctor.
Dr. Rob Schreiber: Well, we'll try to work with you on that.
Schreiber's the chief physician at Hebrew Senior Life in Boston. He says they deliver "low-tech, high-touch" care. But U.S. physicians are typically paid for procedures — tests and scans and the like.
Dr. Schreiber: We do a lot of care coordination working in interdisciplinary teams, which requires takes a lot of time. The way our system is set up, there's not money that's paid for that care coordination and communication.
Schreiber says there's legislation planned to pay for this care, but to date it's founded on Medicare rules that require cuts to offset spending. But experiments show that a team approach to care can save money.
Take PACE, a program for very sick low-income seniors. The PACE center in South Boston keeps 150 people out of nursing homes and in the community, with an array of services including entertainment.
Lloyd Young: You want to stay strong, come to the elderly center. And my name is Lloyd Young, and I'm going to be young as long as I live.
Young's a 75-year-old disabled Korean War veteran. He gets meals, personal care and a full range of medical services from the center. Medicare and Medicaid pay a monthly rate, says the center's geriatrician, Adam Burrows.
Adam Burrows: On average, about $2,100 per member per month from Medicare, and we receive on average about $3,600 per member per month for Medicaid.
Burrows says 25 states have PACE centers, and dozens more are planned. Everywhere it's been tried, it's helped keep frail elders healthier and saved cash for federal and state governments.
And Sharon Levine says Boston University and other medical schools are making sure that doctors in all disciplines get some training in geriatrics.
It's older folks who break their hips, it's older people who have heart disease. So every doctor who has contact with older patients needs to know how to take care of those older patients in the larger sense.
And finally, all of us who are baby boomers will have to take control of our own health — learn to eat healthily, exercise, and manage our chronic diseases. It's essential to stop Medicare from going broke.
In Boston, I'm Helen Palmer for Marketplace.