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American Health Care Trends: Old, Fat and Lazy

The AMA’s recent summary, “Health in the United States: Health Care Trends,” contains both a little hope and a lot of gloom.

Population trends

By 2050, the portion of the population over 65 will double from today to 83.7 million. This means that the prevalence of chronic diseases will increase dramatically. Since 1990, smoking has decreased from 29.5% to 18.1% of the adult population. Likely as a result, strokes fell by 34%, heart disease by 27% and cancer by 17%. That sounds good, but…

Fat and slow

Since 1990, the adult obesity rate (defined as a BMI over 30) has increased from 12% to 29.6%. During the same period, diabetes increased from 4.4% to 10% 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. The main reason is physical inactivity. Only 21% of adults get the 150 minutes of exercise per week recommended by the US Department of Health and Human Services. My observation is that most do not exercise. Many employers now offer wellness programs that provide 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 may come, especially if the federal government turns the health insurance business over to private companies.

Is there a doctor in the zip code?

The AMA reports that primary care physicians are closing their practices and either retiring early or moving into non-clinical fields such as insurance, quality control, the pharmaceutical industry, or even medical informatics. As the demand for healthcare services increases dramatically, an increasing percentage of primary care will be provided by PAs and nurse practitioners. I expect them to have more and more independence. This is not necessarily a bad thing, many of these carers are excellent and offer compassionate and comprehensive care. A possible byproduct of this trend may be an increase in demand for referrals and specialized care, such as referring diabetics to endocrinologists and COPD patients to pulmonary specialists.

Take responsibility or someone else will

A dystopian future is looming where the cost of medical care is more than our resources can handle. In this rather scary situation, someone will have to be denied services, probably either the helpless or those who refuse to accept the mandatory health rules. That hasn’t happened yet. There is still time to make the recommended changes in diet and activity. Remember who could have predicted that everyone would quit smoking?

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