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The American Paradox of Healthcare: 10 Predictions for the Future

A nation's health system reflects its values. When people look at the way they take care of themselves and their fellow citizens, they look at themselves in a mirror that shows the best and worst of themselves.

In light of this, America's healthcare system is a paradox that reflects the strengths and weaknesses of our society. On the one hand, we have brought to the world amazing innovations in health technology, diagnostics, treatments and drug treatments.

Our system has improved the quality of life and longevity of millions of people, increased coverage for the elderly, the poor and the disabled, and is at the forefront of genetic advancements to understand and combat the diseases that have plagued the humanity since we learned to walk upright.

But there is also the fact that these blessings come with their curses. Health care in the United States has been the focal point of decades of political turmoil between Democratic and Republican ideologies about the best way to pay for care.

Millions of people remain without health insurance coverage or have limited access to care. Older residents live longer and it costs more to care for them. The system remains mired in waste, fraud and abuse.

The costs of drugs, medical devices and treatments are the highest in the world, and there is concern that the many advances in genetics, electronic records and communication systems will open doors to privacy and ethical violations where no one never thought.

In fact, there is no better example of America's health care system discrepancy than the astronomical costs that have been spent caring for America's tallest Corona virus victim.

Michael Fleur, 70, of Seattle, Washington, was hospitalized for 62 days at a total billable cost of $ 1,122,901.04. Upon checkout, he received a 181-page invoice detailing expenses, such as room charges of $ 9,736 per day and fan at $ 2,835 per day, among 3,000 other itemized rates.

But you will be exempt from paying this bill because of the coronavirus relief funds that are covered by taxpayers to help insurers and the uninsured bear the costs.

Herein lies the paradox: Mr. Fleur received the best care in the world and was saved from death, but at an astronomical price that would eventually be covered by the taxpayers of this country.

10 predictions

With the Coronavirus pandemic heavily focused on the strengths and weaknesses of our system, here are 10 predictions for the future of healthcare in America:

Profits are a scapegoat for the growing budget deficit and national debt: The US federal budget deficit reached $ 439 billion in 2015 and increased to $ 984 billion in 2020. The national debt is $ 25.7 trillion, which now exceeds the country's economic output. The main drivers of this growing financial turmoil have been massive tax cuts for the wealthy and corporations, increased military budgets, and recent coronavirus relief measures. The distraction from this reality was an attempt to blame Social Security, Medicare, and Medicare. Every federal budget proposal since 2016 began with promises to cut spending on these rights programs and make massive changes to these critical safety nets for the elderly, children, the poor and the disabled. The programs face solvency problems, with Medicare at risk by 2029 and Social Security at risk by 2034.

Anticipation: The realities that led to budget deficits and debt will be fulfilled, but welfare programs have solvency problems that will be addressed through systemic changes. Increases in taxes and age of eligibility, reduced benefits, more liability for personal costs for individuals and tax incentives to cover private salaries for long-term care are options that should be on the table to expand tailored programs. that the population ages and lives longer.

Is health care a right or a privilege? Healthcare in the United States is an odd combination of market-based private care and government / taxpayer benefits. The central debate on our system since the 1960s has been: Is health a right or a privilege? Much of this is due to the idea that health insurance is affordable for everyone if everyone buys it because the risk is pervasive and people should have a "right" to health care. Opponents of the concept argue that health care is an "option" and that no one should be forced to pay for coverage for themselves or others. Supporters of coverage mandates and protection from exclusion say that for everyone's benefit, we must cover as many people as possible with insurance. Opponents say it is unconstitutional for someone to buy insurance against their will. But car insurance is a great example of forcing people to buy insurance coverage for their benefit and everyone else on the road as well. In essence, the arguments boil down to which aspect of a fundamental question you are addressing: do the needs of the majority outweigh the rights of the individual, or do the rights of the individual outweigh the needs of the majority?

Forecast: Total health care spending in the United States will exceed $ 4 trillion annually and consume at least 20% of GDP in five years. Decades of attempts to reform health care will create parallel health care environments in the United States where people choose a government-funded "Medicare for All" model or a concierge health care system for the wealthy who receive private care and organic "country club" provided by doctors, hospitals and services. A decade from now, America will enter the era of the "Healthcare Hunger Games" where the rich have access to the best and services are delivered to the masses through a hybrid Medicare / Medicaid program. run by the government.

The population is aging and baby boomers are retiring: Baby boomers started at the age of 65 at a rate of 10,000 every day for 10 years, and that rate will continue for another decade. By 2030, all children will be 65 or older, and by 2034 the number of people 65 and older will exceed the number of people 18 and younger for the first time in American history. Life expectancy has continued to rise to almost 79 years, and the gender gap between men and women has narrowed: men now only live five years less than women. An aging workforce creates an interesting dynamic among older workers who stay longer for much-needed income and health benefits, and collide with younger workers who enter and try to move up in the workforce

Forecast: Life expectancy will remain on an upward trajectory. The percentage of people who continue to work after 65 will continue to rise, meaning that older people can continue to receive employer-based health insurance, accumulate more savings, and delay collecting social security until they are approaching 70 years to receive your maximum benefit. Older workers will continue to rise as a percentage of the workforce as the idea of ​​retiring at age 65 becomes a relic of the past.

Pressure on LTC Resources: 75 percent of Americans 65 and older are living with multiple chronic illnesses that require professional support and long-term care services. About 14 million people receive some form of long-term care each year. There are 15,600 licensed retirement homes serving 1.4 million residents, 28,000 communities living with the help of more than one million residents, and 13,000 home health agencies serving more than 12 million people in their homes in the United States. Almost half of the people living in nursing homes are 85 or older, and 72 percent are women. The national average cost of home care is $ 100,000 per year. More than $ 230 billion is spent annually on long-term care in the United States, with nearly 60 percent covered by Medicaid, 23 percent paid by individuals "out of pocket" and less than 5 percent covered by long-term care private insurance.

Prediction: At least 70 percent of baby boomers will need some form of long-term care for the rest of their lives. Increasing pressure on long-term care providers and Medicaid to meet this massive influx of demand from the elderly population will force more family members to become caregivers, and people will have to dig deeper into their pockets. The high death rate of seniors in nursing homes due to the coronavirus outbreak will keep more people at home for care and will have a lasting effect on people making decisions about accepting a loved one in the future. Ongoing cost reduction efforts will drive Medicaid to increase eligibility requirements and cost-sharing measures, such as copays and deductions, for recipients of supports and services.

Rural care at risk: Between 2010 and 2020, more than 80 hospitals were forced to close in rural areas of the United States. Contributing factors are the many differences between medical care provided in urban and rural settings, such as the 2 to 1 difference in the ratio of physicians to the population; Travel distance and transportation challenges; Economic and educational differences; An increase in the number of people without insurance and an increase in unemployment; High mortality rates from heart disease, obesity, tobacco and drug use (especially opioids), alcohol use, traffic accidents, and workplace accidents.

Prediction: NRHA has identified 673 rural hospitals at risk in the United States as "at risk of closure." The disparity between urban and rural care will not diminish, and the prevailing socioeconomic and health factors that emphasize the rural hospital system will intensify. Compounding the problem, the impact of the coronavirus outbreak will push many of these "at risk" hospitals beyond the limit. More hospitals will be closed and the government will have to deal with a growing healthcare crisis in the American countryside.

Universal Healthcare / Medicare-for-All: A political storm erupted during the Obama administration that continues to this day, providing health coverage to as many Americans as possible through the Affordable Care Act (ACA or "Obamacare"). Although it was previously covered by more than 20 million uninsured Americans, opposition to this approach remained intense from Republicans and the Trump administration. For the past four years, President Trump has sought to dismantle anti-corruption law through executive, legislative and judicial action. Most of these attempts were weakened or completely thwarted. During the Democratic presidential primaries, candidates presented proposals based on the "Medicare for All" approach that was unpopular with the majority of voters surveyed at the time.

Prediction: The outcome of the 2020 presidential election is a crossroads for this debate. "Global" healthcare as currently configured under the ACA will either disappear under the second Trump administration or evolve and grow in expansion under the new Biden administration. Additionally, the current coronavirus situation driven by racial and economic inequality affecting health and mortality outcomes for some residents will be an additional incentive to find solutions that cover more Americans. An interesting question to consider: Will women be considered people who test positive for the virus have a pre-existing condition?

Employer - Works on a health coverage basis only when people are employed - the vast majority of people receive their health insurance through their employer. About 158 ​​million people (more than half of all Americans under 65) had employment-based (group) health insurance in early 2020. But a major challenge emerged mid-year when 40 million people found themselves suddenly unemployed due to the pandemic. . These people unexpectedly joined the nearly 30 million Americans who no longer had insurance. Some will be able to keep coverage through COBRA and others will apply for individual health insurance plans, but these are very expensive options. Others will turn to Medicaid or other government safety net coverage options. As the US economy stabilizes in a prolonged recession, millions will lose unemployment benefits and health care.

Prediction: The coronavirus is rapidly changing the nature of work and employment in the United States. The workforce switched to working from home and millions lost their jobs; The question now is what will employment be like in the future? Employment-based health insurance will decline with rising mass unemployment, business losses, bankruptcies, and a switch to home-based workers or as independent contractors. An employment-based healthcare system only works when people are hired. It will take time for the United States to recover from the repercussions of the epidemic and re-employ millions of workers. It will be years before the economy returns to pre-coronavirus levels, if that happens. Group coverage will not go away, but poor access to health coverage must be reassessed on the basis of employment as the backbone of America's health care system.

Medical personnel and supplies rapidly regress during a crisis: At best, medical care in the United States can seem chaotic and ineffective. There can be long wait times for appointments, completely different pricing formulas depending on the regions of the country, and a glut of doctors in urban areas compared to a shortage of supply in rural areas. Anyone who has had to wait to be seen in the emergency room understands these and other failures very clearly. But now that the Corona virus has pushed the system to its maximum limits, we can see how fragile the system is and how little supply it is when it is driven by a global pandemic that manifests itself in the form of a national crisis. Caregivers and other workers are being pushed physically and emotionally to the limit as hospitals in hot states like New York, Florida and Texas, California and Arizona have reached 100 percent capacity and have had to use surplus space as playgrounds to care for the sick and freeze trucks to store the dead. As of today, the insurance industry estimates that the cost of treating the coronavirus can reach a trillion dollars.

Prediction: The impact of the coronavirus on the provision and payment of health care will be widespread and long-term. Inequality in health care has been demonstrated across ethnic and economic domains and will need to be addressed. The debate about how to pay for health care will heighten. You will need to address the need for more medical professionals and general support staff, as many will wonder if this is an area they want to be in. The lack of supplies that forced hospitals to draw on collective resources of things like household masks has demonstrated the importance of preparation and the need to store materials. Telemedicine will become more common as telecare becomes effective.

Increased Private Wages and Tax Incentives: Most health care and long-term care services for the elderly are paid for through Medicaid and Medicare. As baby boomers age and the elderly population increases, the pressure on taxpayer-funded benefits has become enormous and a growing threat to longevity. The government is resisting proposals to make major changes to the way Medicaid is funded and administered in the states, and to Medicaid coverage and coverage rules. To offset this imperative, private payment options have been on the rise. For more than a decade, measures to encourage the use of private payment financing in the form of tax incentives, authorizations and consumer disclosures have been introduced in state capitals and Washington, D.C. Long-term healthcare providers emphasize private pay through incentives and discounts,

Forecast: Sales of financial instruments to help people meet their future care needs, such as pensions, LTC life policies and critical illness, will continue to grow. Alternative financing options that support the unique factors of aging and declining health in older people will continue to be more prevalent. The use of reverse mortgages for people looking to age will increase from $ 7 billion to $ 10 billion measured in loan income by 2025. Life settlements to sell a life insurance policy that is not required for a lump sum payment global tax-free markets will continue to grow as this market increases from $ 4.4 billion in 2019 to $ 9 billion by 2025.

Technology: Advances in medical science and technology have improved health care, quality of life, and longevity for centuries. The pace of progress over the past decade has been staggering in human genome mapping, the use of artificial intelligence (AI), medical and orthopedic devices, telemedicine, pharmacology, and digitization of medical records. These developments not only improve health outcomes, but also enable access to healthcare for more people, reduce waste, create efficiencies and save costs.

Prediction: Moore's Law states that computing power doubles every two years, and advances in healthcare will continue at an accelerating rate. Artificial intelligence will increase the ability to analyze data about disease cases and diagnoses and help improve treatment. Genetic testing will continue to reveal secrets of DNA and inherited health conditions, and genetic testing will help people understand the lifestyle changes they need to improve their health and live longer. 95 percent of the population owns a smartphone, making telemedicine and health apps on phones a bridge to bridge the gap between residents who have difficulty accessing care, such as the elderly and the elderly. rural residents. Pharmaceutical treatments will continue to advance for many diseases and conditions, but more emphasis will be placed on vaccine development and management in the wake of the pandemic. Continuous digitization of medical records will deliver numerous benefits, including immediate access to records for physicians and patients, reduced medical errors, cost savings, and efficiency.

The paradoxical nature of America's healthcare system is constantly evolving, sometimes revolutionizing. The demand for healthcare and the costs associated with caring for an older population will drive innovation and challenge our ability to pay for it.

The impact of the pandemic will be long-lasting and will be a measurable factor in the future of our system for years to come. The United States will continue to be a leading force in the world, driving the development of health care and improving the quality of life for billions of people.

However, here at home, our system will continue to be a host of opportunities and challenges.