The chal­lenges ahead—for you and us

Modern Healthcare - - CONTENTS - BY MER­RILL GOOZNER

Re­view­ing the arc of health­care his­tory over the first four decades of Mod­ern Health­care’s ex­is­tence as a part of Crain Com­mu­ni­ca­tions, two ma­jor themes stand out.

First, as a na­tion we have moved in­ex­orably to­ward join­ing the rest of the ad­vanced in­dus­trial world in pro­vid­ing health in­sur­ance cov­er­age for all of our cit­i­zens. Sec­ond, ad­vanc­ing tech­nolo­gies have been a dom­i­nant force in shap­ing how health­care providers de­liver care.

Both are un­fin­ished evo­lu­tions. De­spite im­prove­ments to Medi­care for the old and dis­abled, ex­pan­sions in Med­i­caid for the poor, and, most re­cently, the sub­si­dized in­di­vid­ual mar­ket cre­ated by the Af­ford­able Care Act for those in the work­ing-age pop­u­la­tion with­out em­ploy­er­pro­vided cov­er­age, we still have about 30 mil­lion in the U.S. with­out in­sur­ance.

We’re the rich­est na­tion on earth. Yet com­pared to other ad­vanced na­tions, a 10% uninsured rate is still an out­ra­geously high num­ber.

Let’s hope that by the time that Mod­ern Health­care cel­e­brates its 50th an­niver­sary, we will have fi­nally closed this gap­ing hole in our so­cial safety net. We still have a lot of work to do.

The advance of health­care tech­nol­ogy will al­ways be a part of our evo­lu­tion as a species. Over the past 40 years, sci­en­tists and en­gi­neers made spec­tac­u­lar gains in the fight against dis­ease. From CT scans to elec­tronic health records and tele­health, from ar­ti­fi­cial body parts to tar­geted drugs, from more so­phis­ti­cated di­ag­nos­tic tests to ma­chine-aided pre­ci­sion surgery, the health­care sys­tem can de­liver care to­day that the ear­li­est read­ers of Mod­ern Health­care would have con­sid­ered noth­ing short of mirac­u­lous.

Will we see the same ad­vances over the next 40 years? Un­doubt­edly tech­nol­ogy will con­tinue to advance. But the un­solved prob­lems of to­day—many can­cers, de­men­tia, the in­evitable de­te­ri­o­ra­tion of the body as it ages—re­main un­solved be­cause they are dif­fi­cult if not im­pos­si­ble med­i­cal chal­lenges.

More­over, if we take the long view, the great­est ad­vances in longevity came from pub­lic health mea­sures. Clean wa­ter, bet­ter hous­ing and heat­ing, less ar­du­ous work—these achieved far greater gains in life ex­pectancy than any sin­gle med­i­cal advance.

Mid-20th cen­tury ad­vances like an­tibi­otics and vac­cines sharply re­duced early mor­tal­ity from in­fec­tious dis­eases. But while we oc­ca­sion­ally still get a ma­jor advance against a dis­ease, the ex­ten­sion of life af­forded by most of the lat­est new drugs or other med­i­cal tech­nolo­gies is mea­sured in months, not years.

There is a grow­ing un­der­stand­ing among health­care lead­ers that the next wave of med­i­cal in­no­va­tion must re­turn to its roots in pub­lic health. We can do far more to ex­tend life ex­pectancy to­day if we tackle is­sues such as obe­sity, poor nu­tri­tion, chronic stress, un­em­ploy­ment and un­der­em­ploy­ment, and eco­nomic in­se­cu­rity—the so-called so­cial de­ter­mi­nants of health.

The next 40 years are go­ing to be an ex­cit­ing time to be cov­er­ing a health­care sys­tem that gets se­ri­ous about man­ag­ing the health of our pop­u­la­tion—be­fore it gets sick as well as when it gets sick. Mod­ern Health­care plans to be there—with news, in­for­ma­tion, data and in­sight— every step of the way.

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