The presidential election of 2008 will be the most important event in the history of American health care. While health care is always a hot political topic in any election year (including this one), it is going to be absolutely critical in 2008, no matter what the outcome is this November. Why? Here are a few reasons.
Consumer-deflected health care. There is considerable momentum behind the move to shift costs to consumers, and despite consumers’ bitching, there is little to stop the trend. Health costs for employers have been rising at double-digit rates for almost five years, and employers have finally developed the backbone necessary to stick it to their employees. Because everyone is worried about having his or her job outsourced to India, the employee is eating the cost shift, albeit reluctantly. There is no reason this trend cannot continue for three or four more years, but it is not a long-run solution. Just imagine how cranky we will all be in 2008 when we are paying, out of our own pockets, thousands of dollars a year for health care.
The baby boomers confront retirement security. The oldest baby boomers will turn 60 in 2007, and it is quite likely that this will be exactly the time when the penny finally drops for them: They have not saved enough money for retirement. Most importantly, they will realize that they don’t have the close to $200,000 actuaries tell us they will need for out-of-pocket health care costs. Most of us will have to work forever; we will all become limo drivers in Boca Raton hauling other baby boomers around.
From a soccer-mom agenda to a retirement security agenda. The baby boom has transformed every institution it has touched, from the elementary schools of the 50s to the colleges of the 60s and 70s and the workplace of the 80s and 90s. We boomers are used to being accommodated and being in charge. While Clinton rode to political power partly on the strength of the soccer moms’ support, the 60-somethings of the future will be a powerful political force. Will they anticipate their looming retirement politically in 2008, or will they wait until it is almost too late (2012)? Medicare won’t go bust, they say, until 2017–and maybe further out if you believe some of the optimists. But there is no question that a massive cohort of selfish, insecure, worried, narcissistic baby boomers will expect to be catered to, and I will be at the head of the line.
The fallout from Medicare reform. As I wrote in a previous column, “Medicare Reform as Three Movies,” the new Medicare benefit will be the status quo in 2008. Unless overturned or substantially modified in the interim, the elderly will have real experience with discount cards and doughnut holes, and the pharmaceutical industry will have many of its blockbusters off patent (either generic or over the counter). The 2008 election will be a referendum on the effectiveness of Medicare reform.
What will be the outcome? I don’t know. But I hope we have a real debate about American values of fairness; innovation; and economic, personal and fiscal responsibility. Most importantly, by 2008 we will need to have the national debate about the fundamental and total redesign of health care delivery and the system to finance it. Because one thing we can’t ignore is the reality of 2022, when the peak of the baby boom hits 65 and all of us will be sitting around in nursing homes singing “I got you, Babe.” We can’t extrapolate that demographic onto the current health care system.
Ian Morrison is an author, consultant and futurist based in Menlo Park, California. He is also a regular contributor to H&HN OnLine.