American Health Care Trends: Old, Fat and Lazy

The recent AMA Executive Summary “Health in the United States: Health Care Trends” contains both a little hope and a lot of gloom.

Population Trends

By 2050 the segment of the population over 65 will double from today to 83.7 million. This means that the prevalence of chronic illness will rise dramatically. Since 1990, smoking has decreased from 29.5{c34c06f77d52afff33578e93b7591d6bfac789ab9e1d902f9c4fe14f0d14bf4a} to 18.1{c34c06f77d52afff33578e93b7591d6bfac789ab9e1d902f9c4fe14f0d14bf4a} of the adult population. Probably as a result, stroke has declined 34{c34c06f77d52afff33578e93b7591d6bfac789ab9e1d902f9c4fe14f0d14bf4a}, heart disease 27{c34c06f77d52afff33578e93b7591d6bfac789ab9e1d902f9c4fe14f0d14bf4a}, and cancer 17{c34c06f77d52afff33578e93b7591d6bfac789ab9e1d902f9c4fe14f0d14bf4a}. This sounds good but…

Fat and Sluggish

Since 1990, the obesity rate in adults (defined as BMI over 30) has increased from 12{c34c06f77d52afff33578e93b7591d6bfac789ab9e1d902f9c4fe14f0d14bf4a} to 29.6{c34c06f77d52afff33578e93b7591d6bfac789ab9e1d902f9c4fe14f0d14bf4a}. During the same time diabetes increased from 4.4{c34c06f77d52afff33578e93b7591d6bfac789ab9e1d902f9c4fe14f0d14bf4a} to 10{c34c06f77d52afff33578e93b7591d6bfac789ab9e1d902f9c4fe14f0d14bf4a} of all adults. Not old adults, all adults. The CDC predicts that by 2050, thirty percent of adults will have diabetes. As a result, obesity is now the leading cause of heart attacks. Physical inactivity is a major reason. Only 21{c34c06f77d52afff33578e93b7591d6bfac789ab9e1d902f9c4fe14f0d14bf4a} of adults get the US Department of Health and Human Services recommended 150 minutes of exercise weekly. My observation is that most get no exercise. Many employers now offer wellness programs that give financial rewards for healthy behaviors. This could be a big step in the right direction. Of course, punitive actions denying health insurance to the morbidly obese or uncontrolled diabetics could also be coming, especially if the federal government leaves the health insurance business to private companies.

Is There a Doctor in the Zip Code?

The AMA reports that primary care doctors are closing their practices and either retiring early or moving to non-clinical areas like insurance, quality management, the pharmaceutical industry or even medical informatics. Since the demand for health services will increase dramatically, an increasing percentage of primary care will be provided by PAs and Nurse Practitioners. I expect they will have increasing independence. This is not necessarily a bad thing, many of these caregivers are excellent and offer compassionate and comprehensive care. A possible byproduct of this trend may be an increase in demand for referrals and subspecialty care, such as sending diabetics to endocrinologists and COPD patients to lung specialists.

Take Responsibility or Someone Else Will

A dystopian future looms where the cost of medical care is greater than our resources can manage. In this rather terrifying situation, someone will have to be denied services, probably either the powerless or those who refuse to adopt mandatory health guidelines. It hasn’t come to that yet. We still have time to make recommended changes in diet and activity. Remember, who could have predicted everyone would stop smoking?