Prediction is difficult, especially of the future… -Neils Bohr (atomic physicist)

1. Prediction is difficult, especially of the future…-Neils Bohr(atomic physicist) The Doctor’s World: 2004 to 2054

2. Goals: • Look at the future, with a critical eye • Draw conclusions regarding your training needs • “If you don’t know where you’re going, you might end up there…”

3. Some Sources U.S. Census BureauRAND corporationKaiser Family FoundationConcord CoalitionWHOThe Transformation of American Health Care: The Arduous Road to ValueJohn L. Haughom, MDSenior VP, Healthcare Improvement Also, Drs. Bagley and Greene, from the AAFP’s Graham Center for Policy ResearchMost graph’s souces & annotations in “Notes” view of this presentation

4. Some scenarios….. ….Or, where the heck is my “flying car”?

5. #1. Demographics: Population & Environment

6. Demography is destiny?

7. Growth implies age distribution changes Watch the % greater than 50 years old as years go by….

8. Most of the growth is in the Developing World..

11. Richard Smalley’s notes on technology:Note that explosive population growth is a result of technological advance…

12. And technology is causing some problems…

13. Major scientific groups agree that the globe is warming… Not everyone thinks that’s a bad thing…..

14. 2 out of 3 Australians will have a skin cancer at some point in their lives-National Geographic Death from Air Pollution: 300-500k/yr Africa, 500k-1M/yr Asia Water Pollution: By 2040, 3.5 billion people will not have potable water (10x the number in 1995)

15. Population growth correlates with environmental health risks

16. As population grows, so does demand for scarce resources… The End of CHEAP Oil

17. Petroleum Use

21. U.S. Population Changes

24. 20.5% 18.2% 12.5% 20.5% 4.1% 1900 1940 1995 2025 2040 Aging Americans • By the mid-2020s at the latest, America will become a nation of Floridas ….and then keep aging. 18.6% 18.6% 18.6% Today 18.6% of Floridians are age 65 and over – the highest senior citizen ratio in the country. % of the total U.S. population age 65 and over

27. New Data Projects Alzheimer's Disease in U.S. Could Affect up to 16 Million by 2050 Research Estimates Current Alzheimer Population at 4.5 million Stockholm — New research released today at the 8th International Conference on Alzheimer's Disease and Related Disorders, sponsored by the Alzheimer's Association, indicates that the prevalence of the disease in the United States will increase from 4.5 million in 2000 to between 11 and 16 million by the year 2050.

29. Yet some areas will lose population..

30. Rural areas with a high proportion of population >65 y o

31. #2 Economics

32. General Economic Trends: GrowingSocial Pressures Almost 44 million people have no health insurance • Source: Employee Benefit Research Institute estimates from the Current Population Survey, March 1988-2003 Supplements.a - Results are based on Census 1990-based weights.b - Results are based on Census 2000-based weights.See appendix in Fronstin, Paul. "Sources of Coverage and Characteristics of the Uninsured: Analysis of the March 2003 Current Population Survey." EBRI Issue Brief number 264, December 2003

33. The “L” Curve <-this is not the top of the line… $100,000 = 10-cm (4-inches) high, $1 Million = 1 meter high Partial Graph of the U.S. Income Distribution.   The graph represents the population of the United States lined up, left to right, according to income.  The height of the graph at any point is the height of a stack of $100 bills equaling that person's income. From “The L Curve”: http://www.davidchandler.com/lcurve/

34. Mount Everest This is the top of the L curve

35. Income Inequality is at historic levels

36. Ownership and Wealth in America is more disparate than any other industrialized country on Earth…

39. In 2002, 12.1 million American children younger than 18 live below the poverty line, and one out of every six American children (16.7 percent) was poor. That is more children living in poverty today than 25 or 30 years ago. A child in America is more likely to live in poverty than a child in any of the 18 other wealthy industrialized nations (for which data exist).

41. Income Inequality is a great predictor of homicide rates! (Equal to income alone…) Higher Inequality- Higher Income-

42. Inadequate Investment in Future Generations Age 65 and over $17,688 $21,122 in 2010 • What the federal budget spends on each elderly American dwarfs what it spends on each child. Per capita federal benefit spending in FY 2000, by age group Under age 18 $2,541 in 2010

43. What is our government response to this?

44. A look at the private health care sector...

45. Total Health Costs: A Larger Share of our Economy..

46. Health Coverage for the Non-Elderly 38.3 million 38.9 million The economic boom of the 90’s did not “lift all boats”

47. Health Plan Enrollment for Covered Workers 1998-2001 Source: Kaiser Family Foundation

48. 9.5 7.4 No cost containment effort has worked for long…

49. “The debate over health care is less a pure macroeconomic issue than an exercise in the political economy of sharing.” –Uwe Rheinhardt

50. And most people are not happy…. Source: Kaiser Family Foundation