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Why some memes are bad for our health care system

A version of this commentary appeared in the Vancouver Sun, Winnipeg Free Press and the Telegraph-Journal

Feeling anxious that Canada’s publicly funded health care system is soon to be crushed by the aging tsunami sweeping the nation?

Then take some comfort in knowing that your anxiety may not be due to your genes, but your memes. What’s a meme, you say? British scientist Richard Dawkins defined it as a unit of cultural transmission, analogous to a gene. Genes transmit biological information, whereas memes are ideas that transmit cultural information. Malcolm Gladwell said that a meme “behaves like a virus that moves through a population, taking hold in each person it infects.” Just as some people blame their ill health on bad genes, it’s time we blame the poor health of some of our public institutions on bad memes.

Memes transmit current notions and ideas about health care and they can be highly communicable, spread pandemic-like, and infect quickly and broadly. They can also be extremely virulent and hard to subdue, even when patently false. They can be destructive by raising unnecessary panic and fear, and fuel irresponsible political responses.

“The aging of the population will destroy public health care” is a pernicious meme invoked by demographers, politicians, economic pundits, media columnists and others. Wielding stark demographics, they say baby boomers will soon launch a terrifying tsunami-like assault on our public health care system. Call it demographic demagoguery, but the implications are clear: prepare for disaster!

Boomers are not to blame for rising health costs

But before you go scurrying for higher ground, you’ll want to know, is the “greying tsunami” meme even true? The answer in a nutshell: not really. Statistically, health care spending has risen quite a lot in the last few decades, and the key culprits are general population growth (there are more of us), inflation (things cost more as time goes by), aging (as we get older we use more medical services) and utilization (we are all using more health care stuff, including drugs, doctor visits, screening and diagnostic tests, and hospitals).

The aging population might be causing health care costs to rise, but by how much? Independent researchers and economists conclude that about 1% of the annual increase in health care spending is due to “aging.” Which is to say if overall health spending grows at an annual rate of 5%, about one-fifth of that is because more of us are getting old. In fact, numerous studies indicate that the aging of the population is too gradual to rank as a major cost driver in health care, that it’s more a glacier than a tsunami. Others say the current generation of seniors is extraordinarily healthy, so it’s difficult to predict how much they’ll cost the health system in the future.

Real costs of rising healthcare: Drugs, screening tests, doctor visits

While the aging population is contributing to increases in health care spending, increased utilization (more drugs, doctor visits, surgeries and diagnostic/screening tests) contributed about four times as much. Maybe the greying tsunami should be rewritten as the “tsunami of overmedicalization. ” A BC study found that over the past 30 years population growth accounted for 7% of growth in health care spending, aging 14%, inflation 19% and increased utilization 59%.

Earlier this year, my colleague Jaclyn Morrison and I conducted a search of two large media databases containing all of Canada’s major daily newspapers to see how the phrase “aging of the population” was being used.   If the article focused on the growth in health care spending we asked: ‘Did the article provide an alternative hypothesis to explain that growth?’

We discovered about half of the 132 articles we found mentioned the fact that more drugs, physicians, surgery, technology and specialized care was increasing health care costs.  But the other half of the stories we found reinforced the “Aging Tsunami Meme” by not providing any alternative explanations for the growth in health care costs.

Our conclusion?  Politicians, media spokespeople and columnists don’t always lay sole blame on the elderly for the growth in health system costs, but many of them do.  Those who do deserve a public scolding for transmitting and reinforcing a meme which could shape future health policy options and stifle true debate.

Canadians need an unbiased assessment of things as they are.  There is much to do to improve the public health care system in Canada, so why not immunize ourselves from bad memes so we can debate things with a correct assessment of the facts?

Alan Cassels is a drug policy researcher at the University of Victoria and an expert advisor with EvidenceNetwork.ca.

May 2011