American Health Care Trends: Old, Fat and Lazy

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

By 2050 the segment of the population over 65 will double from now to 83.7 million. It follows that the incidence of chronic illness will rise dramatically. Since 1990, smoking has decreased from 29.5% to 18.1% of the adult population. Probably as a consequence, stroke has declined 34%, heart disease 27 percent, and cancer 17%. This sounds great but…

Since 1990, the obesity rate in adults (defined as BMI over 30) has increased from 12 percent to 29.6%. During the exact same time diabetes rose from 4.4% to 10% of all adults. Jupiter Bat Removal predicts that by 2050, thirty percent of adults will have diabetes. Because of this, obesity is now the major cause of heart attacks. Physical inactivity is a significant reason. Only 21% 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 health programs that provide financial rewards for healthy behaviours. This might be a significant step in the right direction. Of course, punitive actions denying health insurance to the morbidly obese or uncontrolled diabetics may also be coming, especially if the federal government leaves the medical insurance business to private businesses.

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 provide 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 experts.

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

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