Okay, maybe it's time to bring up the subject that nobody wants to talk about.

What's really driving the skyrocketing cost of healthcare?

Partially it's a supply problem--not enough doctors. Medical schools in this country admit and graduate far fewer doctors than they could or should. This is deliberate, and should change. Admissions boards try to limit the number of their students, sometimes maintaining a staff to student ratio of 1:1 or 1:2. They justify this practice by saying it's the way to turn out the best doctors. It also accounts for much of the high cost of tuition at medical schools, another factor in limiting the number of doctors: who can afford it?

But this isn't the elephant in the room mentioned in the thread title.

The other part of the problem is the demand side--more and more services are being required and requested. In part this is due to factors which are addressed in other threads: third-party pay leading to no incentive to keep costs down, doctors being paid via fee-for-service, creating an incentive to jack up the bills with unnecessary procedures and tests, etc. But there is a third reason for the increased demand...the elephant everyone pretends isn't there.

It's old people.

When Social Security was introduced, average life expectancy was 67. The medical advances we've experienced in the last six decades have people living routinely into their 70's, 80's, and 90's. And old people, like old cars, require more and more maintenance as they age.

We have even been able to overcome conditions which even a few decades ago were almost always fatal--heart attacks, strokes, cancers of all kinds. But these "rescue" procedures are expensive. And they leave people alive to continue to accummulate expense.

Glaucoma. Cataracts. Hearing loss. Osteoporosis. Joint replacements. Advancing fragility, leading to more broken bones. Foot ailments. Arthritis. Circulation problems. Oxygen tanks. Chronic diseases which manifest more and more as we age and require more and more interventions and treatments. Pacemakers. Bypasses. Mechanical devices like treatment pumps, wheelchairs, walkers, lift beds and chairs...the list goes on.

It costs more every year to keep people alive and comfortable. Interventions become more and more elaborate, with concommitant greater costs. As medicine continues to advance, the population will continue proportionately aging. And the cost of keeping people healthy and around will continue increasing.

Healthcare costs as a percentage of GDP will continue rising until they are no longer sustainable. Yet we can't set up "death panels" to determine who gets to reach 80 and who has to check out "early".

I believe that this will be the greatest financial and moral challenge our children and grandchildren will have to struggle with, brought more sharply into focus by the retirement of the huge Boomer generation.

So in the end, we come to the Big Question: What are we going to do about Grandma?

Your thoughts, please. And be serious.