Dementia Expectations Longevity Public Health

The Future of Medicare

If you are among the many that have paid into Medicare, you may be wondering how your investment is doing.  Given that Medicare is a pay as you go system that will depend on the success of the economy and tax revenues to pay for the benefits.

It’s reasonable to expect that if budgets deficits grow, and the average age of the population increases, there will have to be some adjustments.  Proposed fixes include raising the age for benefits, increasing payroll taxes, and greater cost sharing.  Some now propose nationalizing healthcare.  The possibilities are numerous with all options having consequences, many of which are unknown.  Regardless of the fix, it will require healthy taxpayers that are willing and able to pay into the system.  So, who might these taxpayers be?  Well, they will be the children of today when they begin earning their adult paychecks.

What concerns me is not so much if they will be willing but whether they will be able to pay.  If you were a banker, you might view this in the context of creditworthiness.  If you have kids that have recently entered the workforce, you may be thinking, “My kids can barely pay their bills much less higher taxes.”  If this was your thought, then you’ve noticed a little crack that’s growing in Medicare’s design.

Of course, young families are also delaying buying a house and delaying children because of school debt.  For anyone that doesn’t appreciate the effect Government-backed education loans have had on education cost inflation, a story you may have heard makes the point.  A generation ago, it was possible to earn enough to pay for books, fees, and tuition at a local college by working summers at a minimum wage job.  Many that graduated in the 1960s and 1970s tell me they graduated with little or no debt.

It’s hardly news that large Government programs can have unintended side effects.  This time around the gremlin was in part a miscalculation of how many young debt-free workers the country could expect to have.

No doubt we will hear these issues aired from many points of view as we get closer to national elections.  Despite demographic imbalances and the overhang of education loans, a greater concern is the state of health of the ones paying taxes over the next 50 years.

A recent article titled, “Children Present a Window of Opportunity for Promoting Health” took a look at the state of children’s health in America.  In my opinion, the article could have also been titled “The State of Health of Your Medicare Investment.”  Granted, from an investor’s perspective, it’s a gloomy read.  On the positive side, the article does identify several problems in children’s health that could be corrected with changes in national priorities.

As you might expect, cardiovascular disease will likely remain the leading cause of disability for the next generation because habits picked up in childhood tend to become the same habits people live with as adults.  While this may seem like common sense, researchers often refine these trends to help make sure we don’t gloss over the obvious.  So, here is what they have as a forewarning.

  • Cardiovascular (CV) risk factors in children and adolescents include smoking, obesity, physical inactivity, unhealthy diets, abnormal cholesterol levels, elevated blood pressure, and elevated blood glucose are all rising.
  • Less than 1% of children have ideal dietary habits.
  • Only about 50% of adolescents follow the recommended amount of daily physical activity
  • Up to 8% of children have high cholesterol levels.
  • Around 20% of high school students use tobacco products.
  • Overall, the prevalence of childhood obesity has doubled over the last few decades and is still rising.

As you have likely observed, habits tend to stay with us for a long time. Hence, it’s reasonable to expect that young smokers will continue smoking into adulthood.  Other habits like refined carbohydrates and added sugars will continue to be major factors in adiposity (the fat you see) and dyslipidemia (the fats you don’t see floating in blood).  Later in life, when you need the kids paying into Medicare, there is substantial evidence these vascular risk factors will increasingly lead to dementia.  Whoops.  Ongoing, of course, will be the progressive accumulation of atherosclerosis (deposits in the inner layer of the arteries) that usually leads to vascular stiffening and plaque formation.  Whoops again.  As the heart pumps harder, the heart remodels in unhealthy ways to carry the load.  Ok, Whoops again.

These vascular diseases have a hundred or more names depending on the organ they end up affecting so what we call heart disease, stroke, and dementia are just the tip of the iceberg.  The point, of course, is that a healthy lifestyle, especially a lifestyle that is vascular protective, is the key – and the sooner the better.

As an investor with a stake in America Inc., you have every reason to be concerned about the future value of your Medicare investment.  According to the Human Capital Theory, your lifetime investment in this venture depends on the knowledge, skills, competences, and health of those that will be running the country when you retire.  Fortunately, all is not lost if action is taken.  For a few thoughts about how to solve this dilemma, read the article “Children Present a Window of Opportunity for Promoting Health.”  When enough people fully appreciate the problem and are ready to vote for change, there is hope.

Should America Inc. be slow to upgrade its ‘board of directors’, all is not lost.  In a country with the freedoms we have, individuals and families can plot their own path. As smart investors know, it’s all about having a plan and timely execution.

Should you be short on plans, let me suggest a few topics from the past that might seem more relevant now that you’ve given more thought to the future prospects of your investment in America Inc.

America needs leaders that understand the root cause of burdensome health insurance cost.  It’s a job-ready and waiting.  My hope is that many reading this newsletter will appreciate how important their knowledge can be as a force for change and become a part of the solution.  Regardless of your party affiliation, they will need you to help them move in the right direction.

            Nancy Neighbors, MD

A Special Movie is Coming

            The movie, The Game Changers, will be shown on September 16th (one night only) at 7:30 pm.  Local theaters showing the movie include:

  • Regal Hollywood 18 – Huntsville, 3312 South Memorial Parkway, Huntsville, AL 35802
  • Cinemark Bridge Street & XD, 370 The Bridge Street, Huntsville, AL 35806

            To purchase tickets online use this link or purchase tickets at the theater.

Creamy Pinto Bean Dip

Serve this lightly spiced bean dip with tortilla chips, spread it on tacos or quesadillas, or use it as a great base for building a batch of Ultimate Nachos.

Yield: Makes 1 1/2 cups


1 tablespoon olive oil

1/3 cup chopped red onion

1 (15-ounce) can low-sodium pinto beans,

rinsed and drained

2 garlic cloves, chopped

3 tablespoons chopped red bell pepper

3/4 teaspoon chili powder

1 1/2 teaspoons red wine vinegar

1/4 teaspoon dried oregano

3/4 teaspoon kosher salt, plus more

1/4 teaspoon freshly ground black pepper, plus more


Heat oil in a large skillet over medium. Add onion and cook until softened, 4–5 minutes. Add beans, garlic, and bell pepper and cook, stirring, until softened and warmed through, 4–5 minutes. Stir in chili powder and cook until fragrant, about 1 minute more.

Pulse bean mixture, vinegar, oregano, 3/4 tsp. salt, 1/4 tsp. pepper, and 1/4 cup water in a food processor, adding water by the tablespoonful if needed, until smooth. Taste and adjust seasoning. Serve warm or at room temperature.  Bean dip can be made 3 days ahead. Store in an airtight container and chill.

By Nancy Neighbors, MD

... Dr. Neighbors provides a blend of traditional family medicine and evidence-based lifestyle medicine in Huntsville, Alabama. When indicated, lifestyle change is recommended as the first line of therapy.

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