April 26, 2007 9:36AM

As We Age

Atul Gawande writes,

Little of what the geriatricians had done was high‐​tech medicine: they didn’t do lung biopsies or back surgery or PET scans. Instead, they simplified medications. They saw that arthritis was controlled. They made sure toenails were trimmed and meals were square. They looked for worrisome signs of isolation and had a social worker check that the patient’s home was safe.

How do we reward this kind of work? Chad Boult, who was the lead investigator of the St. Paul study and a geriatrician at the University of Minnesota, can tell you. A few months after he published his study, demonstrating how much better people’s lives were with specialized geriatric care, the university closed the division of geriatrics.

“The university said that it simply could not sustain the financial losses,” Boult said from Baltimore, where he is now a professor at the Johns Hopkins Bloomberg School of Public Health. On average, in Boult’s study, the geriatric services cost the hospital $1,350 more per person than the savings they produced, and Medicare, the insurer for the elderly, does not cover that cost. It’s a strange double standard. No one insists that a twenty‐​five‐​thousand‐​dollar pacemaker or a coronary‐​artery stent save money for insurers. It just has to maybe do people some good.

En passant, he writes, “We cling to the notion of retirement at sixty-five—a reasonable notion when those over sixty‐​five were a tiny percentage of the population, but completely untenable as they approach twenty per cent.”

So it seems that Medicare is letting down the elderly when it comes to geriatric care. And Social Security is untenable. Who would have thought that government would make mistakes?