Demographic Trends Exacerbate Economic, Political & Healthcare Trends

As Robert Reich says, “Decades of stagnant wages, coupled with skyrocketing costs of living and failed trickle-down policies, have created a middle class in crisis.” Record unemployment numbers mean absolutely nothing to families with no savings and struggling to get by. The next time you hear President Trump boast about the “best economy ever”, know the truth.

Exacerbating the economic, political and healthcare trends is an aging population with fewer young people getting married and raising families. Who will be left in the workforce to pay taxes and support the elderly when they retire?

AS BABY BOOMERS APPROACH RETIREMENT AGE, THEY’LL TRANSFORM AGING IN AMERICA.

• 76 million boomers were born between 1946 and 1964. America wasn’t prepared for that growth, and neither were other nations. There weren’t enough hospitals or pediatricians, or schoolteachers, textbooks or playgrounds, or even bedrooms in our homes.
• The “baby boomer” generation strained institutions every step of the way. They had no voice as infants and children, but now they do. They are politically active and a substantial voting bloc. The more Liberal among them worry about future generations while the more Conservative seem selfish and unwilling to pay for others, saying, “I’ve got mine.”
• The RATIO OF WORKERS TO RETIREES was 159 to 1 in 1940 when the average lifespan was 63.5 years with some 9M Americans receiving Social Security.
• The RATIO OF WORKERS TO BENEFICIARIES was 2.9 to 1 in 2010 when average lifespan was 78.3 years, and nearly 39M people received Social Security benefits. But that was BEFORE the first boomer turned 65. (2020 UPDATE: U.S. lifespan has declined slightly for 4 years in a row.)
• 11,000 more boomers are reaching age 65 every day. Many are retiring and drawing Social Security and Medicare benefits, but 47% of older men and nearly 24% of older women still work. 40% of them are low-income (below 150% of poverty level) and will need significant public assistance.

2000 MARKED A MILESTONE. 

For the first time there were more people over 60 than children below 5, according to the United Nations.

• By 2029, when all baby boomers are 65 years and over, more than 20% of the US population will be over 65 (US Census). That 1-in-5 estimate is up from 1-in-7 today, meaning 80M people will be 65 or older, up 30M from today.
• By 2035, the first boomers will be in their mid-80s, and 1-in-3 U.S. households will be headed by someone 65 or older. The number of HH with a person with a disability will reach more than 31M, an increase of 76% over current numbers. 27M of these HH will have an occupant needing help with household activities such as driving, cooking, and cleaning. 12M will have someone who needs help with self-care, such as bathing and eating. Finally, nearly half of all adults will age in low-density places that lack public transport or nearby neighbors and services.
• By 2050, the older generation will be larger than the under-15 population. (U.N.) 81M Americans will be 65+, 8.7M will be 90+, and 1M will be 100+. (US Census) And today’s young people will then be part of the 2 billion-strong population of older persons.  (U.N.)
• Put another way, 20% of Americans will be elderly (65+) by 2050. That’s up from 12% in 2000 and 8% in 1950. (US CBO) Age 85+ will grow the fastest over next few decades, reaching 4% of population by 2050, or 10 times its 1950 share (US CBO)
• 9 million Americans are now 90+, up from 600,000 30-years ago and 100,000 100-years ago. They had a median income of just $14,760 in 2010, about half of it from Social Security. Some 37.3% of them lived alone, 37.1% lived in households with family or others, 23% stayed in nursing homes, and about 3% lived in assisted living or other informal care facilities. (US Census)

SENIORS AND THOSE WITH UNHEALTHY LIFESTYLES CONSUME MORE RESOURCES.

• 2/3 of all people who ever lived to age 65 are still alive today, according to some estimates. They have better Nutrition and Technology to help extend their lives. But despite living longer than previous generations, US boomers are less active and have higher rates of chronic disease and disability. And these preventable chronic conditions account for 90% of all health care spending. (HHS)
• Almost 39% of boomers are obese, compared to about 29% in the previous generation. 52% report a sedentary lifestyle, compared with only 17.4% of the previous generation. And only 13% say they’re in “excellent” health, compared to 32% in the previous generation.
• 117M Americans suffer from multiple chronic conditions (MCC), according the CDC, and that includes one in 15 children. 66% of the total health care spending is associated with care for the >25% of Americans with MCC.
• 77% of people over age 65 live with two or more chronic conditions. (HHS) About one-fourth of people with chronic conditions have one or more daily activity limitations that require help. (CDC)
• Heart disease, cancer and stroke account for more than 50% of all deaths each year. (CDC) Global cancer rates are expected to increase 50% to 15 million by 2020. 40% of cancers can be preventable. Nearly 70% of deaths result from non-communicable diseases today, and it will grow to 75% by 2025.

SENIORS AND THOSE WITH DISABILITIES  NEED MORE CARE.

• 37M Americans have a disability that requires some assistance or limits what work they can do. (It’s not just seniors but 11.9% of the 304M total US population). 14.3M seniors 65+ have a disability (36.7% of the 39M senior population).
• Of people age 85-89, 69% report having trouble doing errands, visiting a doctor’s office, climbing stairs or bathing, versus 82% of people age 90-94, and 91% for age 95+.
• Alzheimer’s care can average 47hrs/wk/patient. The 5.3M Americans with Alzheimer’s today (12.5% of 65+, 43% of 85+) will grow to 16M by 2050. We already spend $172 billion/yr treating Alzheimer’s, and that will likely grow to $1.08 trillion/yr by 2050 with increased longevity and number of cases.
• Arthritis is the most common cause of disability, with nearly 19M Americans reporting activity limitations from Arthritis.
• Preventing chronic conditions costs significantly less than treating them. That’s why many employers now provide wellness programs to help keep workers healthy and productive, and insurers are starting to better coordinate care so seniors stay healthy longer.

 U.S. HEALTHCARE SPENDING IS OUT OF CONTROL. 

• U.S. healthcare spending already exceeds $3.65 trillion (2018), an increase of 4.4% over 2017. That’s $11,212 per capita, the highest in the developed world, twice the average of other rich nations, and about 18% of GDP, going to 19.4% by 2027. The U.S. healthcare market is almost half of the $7.6 trillion global healthcare sector. The new term is Healthspan, not Lifespan.
• U.S. health outcomes pale by objective metrics. Even with all we spend, we rank 25th in the world for life expectancy (below Chile & Greece – Japan leads) and rank 47th in infant mortality (2nd lowest in developed world and even ranked below Cuba!).
• U.S. healthcare spending is concentrated in a relatively small percentage of the population. While nearly 15% of the population had no health care expenditures in 2017, only 5% accounted for over half of all healthcare spending (HHS). About 3/4 of expenses for persons in that top 5% were paid for by private insurance and Medicare, recognizing that’s why we have insurance — to broaden the risk pool. Inpatient hospital care accounted for 40% of spending for persons in the top 5% of the spending. Persons ages 65 and older and whites were disproportionately represented in the top spending tiers.
• At the current rate, costs could reach $13 trillion by 2030 and bankrupt the nation because of Obesity and the 70M Baby Boomers who will soon reach 65, retire, and take Social Security.
• The trends are not good, as U.S. middle-income households spent 51% more on healthcare in 2010 than a decade earlier, and health insurance premiums have risen 4-5 times faster than wages and inflation.
• A dramatic new approach is needed, and its urgency is near critical. But that won’t be politically easy with the powerful medical industrial complex resisting change. The insurers, hospitals, pharmaceutical companies, testing companies, and medical equipment providers collectively act like a cartel and spend more than three times what the military-industrial complex spends in Washington. (“Bitter Pill” by Steven Brill)

These are just some of the stats I’ve accumulated here at Modern Health Talk, an altruistic website and blog about healthcare technology and policy.