Cloud of HealthCare Anxiety, Part I: Demographic and Economic Realities

Cloud of HealthCare Anxiety, Part I: Demographic and Economic Realities

These postings are committed to the belief that the salvation of the health care system in the United States will not spring spontaneously from a single brilliant piece of legislation.  It will not come from a single new care delivery philosophy, nor a new trend in ambulatory care design.  It will not come from CQI, PDSA or Lean.  All these things will have an impact, but none will result in a system that delivers high quality outcomes at an affordable price in a sustainable manner.  The ultimate salvation of the system will emerge from a thousand points of innovation...patients and providers and educators and researchers around the country -- and around the globe -- experimenting with new delivery systems...new technologies...new methods of training the next generation of providers.  The challenges are great.

We are on the cusp of the greatest transformation in the management of health since the advent of antibiotics and anesthesia.  As in any time of great change, it is rife with uncertainties and anxieties.   The "The Cloud of HealthCare Anxieties" (see below) looms over the profession.  It impacts career choices of the young.  For those later in careers, it sometimes encourages early egress from a profession which can and should keep aging providers meaningfully engaged with important work.

Demographic and Economic Realities

The math is inescapable.  The baby boom population is now hitting retirement age.  Over 8,000 Americans turn 65 every day.  As the pig-in-the-python generation begins to retire, there are certain realities at play.  We (the boomers) will consume more healthcare services.  We will visit the doctor more often.  We will develop more chronic medical conditions.  Much of this is the inevitable consequence of growing older.  Some is due to changes in diet, exercise and habits that make us more susceptible to disease.  Whatever the reason, we will consume more healthcare resources.

This increased demand is will be accentuated by generational and technological trends.  We are an entitled generation.  We have enjoyed an unprecedented standard of living.  We want what we want, we want it now, and we want it at the best possible price, in the most convenient manner possible.

The increased demand will occur in the face of increased transparency of data.  We want to comparison shop.  We want comparative quality information on-line.  I imagine few people purchase a car today without checking on-line ratings.  The same will be true of healthcare decisions.  Consumers will demand information, and in the absence of perfect information, incomplete information will do.  The numerous sources of online information about quality of physician care -- deeply flawed today --- will continue to grow in depth and sophistication.  However much some may wish, the genie will not go back in the bottle.

The increased demand will occur in the face of a $16.5 trillion federal debt.  It will occur during implementation of the Patient Protection and Affordable Care Act, a trillion dollar piece of legislation that relies on unproven (and likely overestimated) expense savings, and neglects minor "rounding errors" like the unbudgeted $330 billion needed to correct the Sustainable Growth Formula.

As we have more people to serve, and less resources with which to serve them, we simultaneously invent more things to do for people -- more diagnostic tests, more pharmacologic options, more high tech procedures.

Bottom line, there will be less resources available to support a system with increasing demands.  A bad combination.

Next: Workforce