Consider this: The iconic American family - married couple with children - will account for just 22% of households in 2010. The most prevalent type of household is a married couple with no kids, followed closely by single-person households.

With families taking their children to pediatricians, and seniors increasingly seeking out specialists, what is the future patient base for the family practice physician?

Take a look at SLHI's recent report, Goodbye, Hello: The Future of Primary Care, Part One and Part Two, for a comprehensive look at this fascinating topic.

Cost Shifting on Steroids

Several years ago SLHI funded a study by the Center for Health Information Research at ASU on the effects of Medicaid disenrollment on health care use and cost. Using 2004 data on both insured and uninsured children in Arizona, the study projected that a 10% disenrollment would increase the cost of care per child by $2,121 annually, due to a shift in care from ambulatory settings to more expensive emergency departments and an increase in hospital days.

Now consider the Governor's budget proposal to eliminate KidsCare and save the state about $23 million by disenrolling almost 44,000 children. Let's be wildly optimistic and conclude that half of these children will find coverage somewhere else, leaving the other half without coverage. Using health care costs of almost six years ago, we can conservatively predict additional costs of close to $50 million for the state's health care providers - more than double what the state "saves" in the general fund. If we used cost data from 2009-2010, of course, the amount would be considerably higher.

Imagine doing a similar analysis for the 310,000 people who would be disenrolled from Medicaid under the Governor's budget, or the approximately 17,000 adults who would be impacted by eliminating funding for the Arnold v. Sarn lawsuit. And so on.

If you think hospitals, community clinics, nonprofit agencies and other providers of health and human services are at the edge now, just wait. It's cost shifting on steroids. It's unfair, ineffective and inefficient - and that's just for starters.

But the Governor is right about one thing: If someone has a better plan to eliminate the state deficit and offer "real solutions" to the problems facing the state today and into the foreseeable future, they should come forward. Carping from the sidelines won’t cut it. Get involved.

The Single Greatest Threat

to U.S. budget stability is federal healthcare spending, according to a recent report from the Congressional Budget Office (CBO). Under current law, Medicare spending will nearly double from $528 billion this year to more than $1 trillion in 2020, with Medicaid spending coming in at $458 billion.

U.S. healthcare spending rose to almost $2.5 trillion in 2009 – 17.3% of GDP. Medical spending has outpaced the broader economy for decades, and in a mere two years the federal government will be paying for more than half of it. With millions of boomers ready to sign on to the federal health care rolls, we can anticipate health care consuming upwards of 20% of GDP in less than 10 years.

Reality, some say, is a consensual hallucination. Certainly the linear projection of our health system status quo, with infinite desires meeting finite resources, fits that definition.

The Death of Wisdom

There's an old story about the history of civilization that goes like this: In the beginning, humans sought wisdom. Wisdom proved hard to obtain, however, so we turned our attention to seeking knowledge. But even knowledge became elusive, so we sought information instead. Now information itself is questionable. All that's left is to look at the data.

Wisdom, in other words, has been replaced by the pie chart.

Today, we live in an immediated culture. Wisdom can't live here. Get The Drift to find out why.

Compliance You Can Stomach

If all goes well (and with your permission), in 2011 Proteus Biomedical will be emailing reports on prescription drug performance and compliance from your stomach directly to your doctor. It works like this: patient swallows a pill with both medicine and a tiny sensor chip (where stomach acid acts as a battery for the chip), chip transmits to a skin patch, the skin patch to a cell phone, and the cell phone to your doctor.

Technologies like this have the potential to save as much as $290 billion annually in increased medical costs due to people not taking medications as prescribed. Drug adherence is only 50 percent in developed countries like the U.S., so the potential to reduce costs and improve outcomes is huge.

We didn't include this particular technology in health care scenarios for Arizona in 2030, but we should have. Here, technology could literally "save us" from ourselves. There's this pesky little problem of privacy, of course, but Proteus is "working" on that. The pill is in clinical trials for heart disease, hypertension and tuberculosis, and will begin testing in psychiatric illnesses soon.

One of science fiction's favorite themes is a world where humans have become machines that are vastly superior to the old biological "wet ware" version. Today, you take the pill. Tomorrow, you are the pill, so to speak. Will we still be human then? More to the point, will we even care?

Ruby, Don't Take Your Cake to Work

Join your company's wellness program instead. If your employer doesn't have one, get them to start one. A recent meta-analysis of the literature on costs and savings associated with workplace disease prevention and wellness programs found that medical costs fell by $3.27 for every dollar spent on these programs, and absenteeism costs fell by $2.73 for every dollar spent.

What a concept: investing in prevention and wellness to lower medical costs, improve health and increase productivity. But we have a long way to go. In a 2006 survey, only 19% of companies with 500 or more employees reported offering wellness programs. Small businesses are slower still to offer such programs, and many of those offered are limited in scope.

If you're an employer, start with a health risk assessment for your workers. Provide self-help educational materials, counseling, on-site group activities and seminars, perhaps fitness center membership as a benefit option, financial incentives, etc. The important thing is to get started and raise awareness. Opportunities will follow.