American health care would change dramatically even without reform

By guest blogger Robert Field:

The debate over how reform will change health care tends to miss the real point. Health care is already changing dramatically and will continue to do so regardless of anything the government does. Forces are afoot that no one can stop.

What are these forces? First, there are changing demographics. America is becoming bigger, older, and more diverse. Our population will reach almost 450 million by 2050, which means there will be a lot more people to take care of. There will also be many more elderly, about 80 million, and they're the ones most likely to get sick. Since women tend to live longer than men, the aging population will have a higher percentage of females, especially in the older age ranges.

America is also becoming more ethnically and racially diverse. The percentages of Asian-Americans, Hispanics, and African-Americans are all increasing relative to whites. Different groups can have different health needs, and the system will have to adapt.

Americans are also, unfortunately, becoming sicker. The rate of chronic disease is increasing dramatically, especially for diabetes, hypertension, and high cholesterol. Much of this is caused by the ballooning rate of obesity. As of 2009, the population in every state but one (Colorado) had an obesity rate of at least 20 percent, many were significantly higher than that. The chronically ill require more care, and this care is often very expensive.

Aside from changing demographics, health care itself is becoming more complex. Technology is transforming almost every aspect of medicine, from the way operations are performed, to the methods used to develop drugs, to the means by which physicians communicate with patients. Add to that the revolutions in genomics and nanotechnology, and the science of medicine is changing before our eyes.

However, this revolution comes at a high price. Every year, health care costs rise substantially faster than costs in the rest of the economy. Health care now represents over 16 percent of the gross national product (about one out of every six dollars spent), and by 2020, it is projected to represent over 20 percent (about one out of every five). Many factors are behind this trend, and there is no end in sight. The health reform law made a start at controlling costs and will save Medicare about $100 million a year by 2020. However, this is only a start.

No matter what the health reform law does, these forces will continue at work. Health care as we know it today was destined to change radically long before the Obama plan was even imagined. The measure of the law's success will be how it confronts a revolution that is already underway.

Find earlier items by Robert Field here, including this examinaiton of the legal challenges of the Affordable Care Act (Obamacare).

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