We can delay no longer. For many of the past several decades we have pursued only half measures and lip service toward needed response to a tidal wave of demographic (particularly aging and extended life expectancy) and financial change…but, more importantly, spending on individuals.
Federal projections, done by the Congressional Budget Office, for Medicare and Medicaid have identified that spending per individual will have a greater impact on overall cost growth than would demographics alone. Their projections show that excess cost growth, that which is beyond the costs associated with population growth for Medicare and Medicaid eligible persons, is growing at double the rate of the population. That is, we can spend more than we need to spend…and we do.
We spend more per person because technology, drug spending and our own medical capability have allowed more discovery of disease and more treatment options. Today there are roughly 50 million Medicare beneficiaries. Based on current financing for Medicare coverage it takes approximately 3.5 workers paying taxes to support one beneficiary. Due to the demographic age wave we expect to have 78 million Medicare beneficiaries by 2030, but we will have only 2.3 workers to support each one. The financial implications for the future are dire if change does not occur because the tax burden will grow immensely.
What we know is this:
1. Aging populations will make significant demands on health care services, not only in the US, but globally as well.
2. Aging physicians, nurses and technicians will retire placing an even greater burden on new caregivers who, in turn, will demand more professional pay and benefits commensurate with this additional burden.
3. Providers of all kinds, professionals, suppliers, hospitals, institutions serving the elderly, will be forced to deal with more diverse constituencies.
4. Growing income disparity will undermine needed access to healthcare.
5. Acute diseases will continue to evolve into chronic diseases; as an example Alzheimer’s Disease will be at crisis proportions in the US by 2030.
6. Obesity and other life style choices (smoking, poor diet, lack of exercise, high stress work life, limited sleep, too much alcohol) will drive growth of chronic disease in adults as well as children.
7. The current approach to dealing with chronic disease in the US is unsustainable.
We must change our approach. We have traditionally developed strategies, institutional settings, medical techniques, clinical research, medical training and education, drug therapies, etc. to address the various conditions presented by individuals and patients. These are an important aspect of care for the population and it worked as long as we got paid. Granted there is still a huge need to address a variety of clinical issues, but there will be less money to address them unless we can refocus our efforts and rechannel some of the current spending on healthcare.
In a report by the Healthcare Excellence Institute they cite that 31% of US healthcare costs can be directly attributed to behaviorally induced chronic conditions. The Robert Wood Johnson Foundation has attributed that up to 40% of the US healthcare burden is due to social and economic factors. If 71% of US health issues are due to something beyond our medical system capability to control then other means are necessary to address these issues. If only a fourth of this number (18%) can be recaptured through societal and cultural acceptance for needed behavior change in the population we will do ourselves and our neighbors, family and friends a big favor. We can reduce the expected and forecasted tax burden on our children and grandchildren, we can live healthier and happier lives, we can focus needed and expensive healthcare resources where it is best spent, and we will become a more vibrant and sustainable nation.
Like our national efforts to reduce smoking, which have made somewhat of an impact, it will take coordination in a variety of settings, not just healthcare, but education, government, industry, in short a full on national and community effort. We must shift from healthcare to health. It is likely to take generations; so let’s get started.