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We All Want Longer, Healthier Lives. But It's Going to Cost Us.

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By David Brown
Sunday, January 11, 2009

Over the next few months, this country will engage in the first serious national discussion on health care in 15 years. Most of the talk will be about ways to make medical insurance available to all U.S. citizens. There will be a fair amount, too, about the need to make the hodgepodge "system" of American health care safer, better and more efficient. What we're unlikely to hear, though, is something like this:

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Arresting the growth of health care spending in the United States is impossible. The policies and programs we're suggesting will either accelerate the upward trend or slow it temporarily, but they won't stop it. Health care costs will go up year by year until you die, and probably until your children die, too.

This difficult truth, which has emerged over the past half-century, is leading the United States and the rest of the industrialized world into a new era of humankind.

We are on a collision course between our wish to live longer, healthier lives and our capacity to pay for that wish. Whether we can somehow avoid the collision is perhaps the most important domestic issue of this century. From now on, health care costs will be up there with globalization, terrorism and climate change as a force shaping our world.

For most of recorded history, food production was the chief goal of human labor. In the United States, that time is long gone. We spend a little less than 10 percent of our income on food, down from 25 percent in 1930. We spend twice as much -- 21 percent -- on shelter. But health care -- that's where we really get our wallets out.

Last year, 16 percent of the nation's gross domestic product went for health care, about $7,600 per person. In terms of human effort, health care is the new food. By 2016, when it reaches 20 percent of GDP, it will be the new shelter. If it grows at its present rate through the first three-quarters of this century, it will consume 38 percent of GDP by 2075. It will then be the new food and shelter.

This isn't a mistake. If it were, we might have a chance of stopping it. It's success -- the way things are supposed to be, and the way we want them to be.

"At the end of the day, when it comes to controlling health care costs, the enemy is us," said Drew Altman, head of the Henry J. Kaiser Family Foundation. "Americans want the latest and best in health care technology, and we want it down the street, and we want it now."

Medicine lies at the intersection of two profound forces. One is the desire to survive, which motivates all living things. The other is the ability to make things, which distinguishes humans from other animals.

Crowding that intersection are thousands of opportunities for avoiding or curing an illness, feeling better, living longer and being happier than our grandparents ever could have imagined. These opportunities take the form of implantable defibrillators, replacement knees, periodic colonoscopies, weight-loss surgery, life-long antidepressants, anti-retroviral medicines, breast tumor gene scans, biologically targeted chemotherapy, heart-lung transplants and prenatal tests for dozens of dread diseases.

These are just a few of the fruits of our desire to survive and our capacity to create -- and there's lots, lots more right around the corner.

All these things, of course, haven't come for free. Health care spending has grown faster than the economy, by an average of 2 to 3 percent a year, at least since the end of World War II. In the first five years of this decade, it averaged 6.9 percent a year.


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