The Future of American Healthcare

April 7, 2013

The future of American Healthcare

Most Americans will soon begin to see major changes in health care delivery. The changes will likely be mostly negative for the vast majority, but not for everyone. For example, those without health care insurance or with pre-existing conditions should see improvements. I would bet many of the young and healthy who have previously chosen not to buy health insurance might not like being required to do so.

Some pertinent facts: First, as deeply as our nation is in debt, our leaders have shown no ability to even slightly reduce spending, even though nearly 40% must be borrowed. Second, new health care laws (Obamacare) will add many millions to the health insurance rolls, and the rest of us will pay more as a result, either with higher costs, or reduced services...or likely both. Third, 78 million baby boomers began retiring and collecting benefits in 2011, and are expected to live an average of 19 years after retirement. This huge flow of retirees will continue needing entitlement resources until the last of them die around 2050.

Fourth, the boomer retirement period coincides with a projected decline in our working-age population paying taxes from three per retiree today to two within a couple of decades. Fifth, America (government and private) already spends twice as much per capita for health care compared to any other developed nation. Sixth, America currently has a shortage of primary care physicians, and a recent study in The Journal of the American Medical Association says the shortage will reach nearly 50,000 by 2020.

So, what health care changes can Americans expect in this new reality? Well, if you are wealthy, none. The wealthy will buy whatever health care they want. Many of this subset will use "concierge medicine" providers. Physicians in this niche provide their services for cash retainers, and simplify their lives by having a smaller pool of patients paying in advance for future services. Patients, in exchange, receive guaranteed 24/7 physician access instead of waiting in lines.

What about the rest of us? We will have rationing of access to all types of health care providers, tests, and treatments. Physician's assistants or nurse practitioners will increasingly become our primary care providers. And, while their level of education is not equal to a physician's, they can certainly cost-effectively diagnose and treat common ailments and provide lower-cost triage services.

The citizens of every other developed nation have access to government paid health care, spend far less than we do, and have better overall outcomes, but not without rationing. For example, in most of these countries the primary objective for the terminally ill becomes controlling pain, not prolonging life. And, many elective surgical procedures have long waiting periods. Financial reality simply makes it irrational to do otherwise.

Depending on the information source, it conservatively appears about half of America's health care dollars are spent on the elderly, with about half of that spent in the last year of life. Our family watched in horror as my wife's father spent his last week of life in a large hospital in Indianapolis dying from chronic emphysema. He was visited by more specialists than we could count, and was subjected to multitudes of medical tests...none aimed at saving his life. He even received a flu shot on the day he died! Honestly, it seemed he was kept alive as long as possible so the doctors and hospital could maximize revenues from his misfortune.
So, what can you do about your own health care? Beyond inheriting, marrying into, or accumulating wealth, you'd be smart to immediately initiate steps to improve your own life-style. If you smoke...stop. If you are obese...lose weight. If you live a sedentary life-style...get moving. If you have an unhealthy diet...change it. If you drink too much alcohol...moderate. Society will increasingly find it unaffordable to pay for treatment of diseases consequential to poor life-style choices.

On the brighter side, reduced resources should also result in less waste, with fewer unneeded surgical procedures, tests, treatments, and referrals to specialists. We should also see the long-promised implementation of paperless patient record management aimed at optimizing the coordination of health care delivery. If we're lucky we might even see some long-needed tort reform. Finally, we should see super computers, such as IBM's Watson, being used to help health care providers more effectively diagnose diseases and determine best treatment options. Imagine a future when a computer at Walmart acts as your primary health care provider...don't laugh, it's coming!
Some CVS Pharmacies and Walmart stores have already opened in-store health care clinics staffed by nurse practitioners and physician assistants. It's not exactly concierge medicine...but may beat waiting for an appointment for minor health issues.

Finally, our leaders face an important decision about whether to allow the free market to drive necessary cost and efficiency gains, or place all Americans on a federally paid system like Medicare. Either answer has pros and cons.

If my writing seems particularly choppy today it's because I'm trying to follow my own advice about improving my health. Walking on a treadmill while typing is a lot harder than walking and chewing gum:-)

These are my opinions. What do you think?


Mike Tower