If you ask the political types, they'll tell you that the Supreme Court's ruling on the constitutionality of President Obama's Affordable Care Act is a pretty big deal. They'll say that the "hotly awaited decision" has "defined President Obama's legacy" and "will have an immediate and long-term impact on all Americans." And the constitutional significance of the decision is historic. Yet from a healthcare point of view it has always and continues to leave most Americans uninspired. That's because while the Supreme Court has green-lighted a truckload of reforms, American healthcare remains perfectly ill-fit to meet 21st century needs.
And most Americans get this. Very few see "Obamacare" as the solution to either their individual needs or the overall woes of the American healthcare system, which accounts for why even now, popular polling weighs against the President's Affordable Care Act. The political class, of course, continually fails to notice this, and they persist in trying to address American healthcare anxiety through reforms that fit their political lens.
What is driving Americans' interest in healthcare -- and this is true for much of the world, as well -- is a level of anxiety much deeper and far more profound than anything that can be fixed through a national plan that emphasizes "individual mandates," "cost containment" or "coverage." What underlies Americans' fears is that we do not have a system that is aligned with 21st century realities. Americans get this intuitively, and therefore have never really embraced any of the "Inside the Beltway solutions." We get that reform of a system which was made, literally, for a different time just doesn't do it. We get that there have been huge transformational changes which the Affordable Care Act ignores. And so our anxieties and fears persist.
First is the new wave of demand brought by the aging of the American and global population. With 77 million baby boomers in the U.S. "getting old" along with 450 million of their peers worldwide, there is simply an increase in the need for health products and services. "Seniors," far more than any other population segment, must juggle multiple conditions, and they are going to require an unprecedented quantity of healthcare system over the coming years. And with America and the world experiencing a birth dearth, societies will continue to "get old" well into our 21st century, thereby challenging the traditional model of enough citizens under 60 to take care of those over that age as Stephen Philip Kramer writes in the current issue of Foreign Affairs.
A few decades ago, when America's boomers were young, we were more concerned with education and infrastructure build. But now, as we age and NCD rates skyrocket -- with the risk of cardiovascular disease doubling for each decade of life after age 55 and Alzheimer's affecting almost one-in-two over the age of 80 -- the focus of health reform needs to be on meeting the swelling needs of aging populations, which is the source of the anxiety. Prevention, cures and effective management -- not coverage -- is what animates. Our greatest fear is not that we won't be able to afford Alzheimer's, which might be true, it's that we'll actually get it. Do something about that and you've answered the political demands. You've also started to address 21st century health needs, and not just juggle budgets to try to pay for it.
Second, the explosion of new technology -- innovative breakthroughs in medicine, surgery, technology and diagnostics -- is out there. Americans expect to have it, and at a deeper psychological level, we expect it to work. This causes fear and anxiety. Somewhat understandably, Americans have sky-high expectations for what medical technologies can do, and so a certain amount of disappointment is all but assured. The Affordable Care Act does nothing to assuage this fear, either.
Third, the information revolution creates unrealizable demands on the American healthcare system because of the extent to which medical information has been democratized. Between Google, medical journalism and new platforms like Alliance Health Networks that enable medical social networking, people now have access to information that was once held privately within the circles of science and medicine. There are tremendous upsides to this democratization, but it is also leading to new and unrealistic hopes. And it leads us to the problem of figuring out how to align the democratization of information with what our medical institutions can actually deliver.
The Supreme Court's decision won't be much more than a blip on the healthcare radar for most Americans. It does not solve, nor does it promise to address the underlying anxieties, fears and disappointments of the American people, a consequence of the big three impacts: population aging, availability of new innovative technology and the information revolution. This is why most Americans have viewed the President's initiative with a resigned, cynical shrug. Nor are we alone in our anxieties. As the UK, Italy, Spain and Sweden struggle to cope with outdated national healthcare plans, the U.S. has chosen to enter into one. Even in Britain, where the NHS has been a source of national pride for decades, the new provision to allow people to "opt out" has been widely applauded. The real issue is how to make the 20th century institutions and structures of healthcare relevant to 21st century realities.
So, as the news goes down in constitutional history, we remain shackled by misunderstood analysis and our energy remains wasted on trying to re-engineer a 20th century plan for 21st century needs. With new demands pressing the health system, we need to figure out how to reconfigure the supply. If we don't, the baby boomers in the U.S. and around the world will be prevented from aging in healthy, active and productive ways.
Eric Segall: Ten Fun Facts (and Morals) About the Affordable Care Act and the Supreme Court.
As a 63-year-old male, I am already experiencing many of the discontents of old age. We could offer citizens a choice at 60 or 65 to elect euthanasia in return for a consideration - say, a portion of one's Social Security to be available to one's children or the sort of pleasant final exit depicted in "Soylent Green."