Huge Challenges Cannot Be Avoided


Helen Darling

Helen Darling is president of the National Business Group on Health (until recently, the Washington Business Group on Health). The group’s members are 185 of the nation’s largest private and public sector employers representing about 40 million workers, retirees, and their families.

By 2009, there may at last be a general recognition about the lack of safe care and the poor level of quality in our country. Committed effort by employers and the government will be needed to tackle some disturbing trends.


As a nation, we are just beginning to directly experience the costs and health effects of an epidemic far larger and more dangerous than any that we have experienced in the 20th and 21st century, that is, the epidemic of obesity.

It is the scale of the problem that is so shocking. First, nearly 70 percent of U.S. residents are either overweight or obese. Nearly 30 percent are obese. On average their inpatient and outpatient health spending alone is 47 percent higher than for those people who are not obese.

They are almost certain to become diabetics, and they suffer from heart disease, knee and back problems, and depression. They are already costly to employers and the public sector. The problems will get much worse. Even more alarming is the heartbreaking growth in the number of obese children and adolescents.

Talent shortages

All workforces in the U.S. will be struggling with demographic challenges as the big baby boomer population ages into retirement and old age. The age cohorts immediately behind the boomers are much smaller and the group of people who are the new employees is still fairly small. The younger children of the boomers — known as the Millennials — will begin joining the workforce over the next five years and there are many of them but not so many as we will lose to retirement. So workforces are having to do more with less or rely on more capital-intensive technology to improve productivity.

Health care, though, is a particularly complicated field and relies more on people — nurses, physical therapists — who care about working with people and are in it more as a mission than as just any job. Yet, for the reasons discussed above, it will be less and less satisfying, making it harder to recruit people into health care.

Constant recruitment problems will add to the stress for all. Given the long, costly education and training process for physicians, and increased dissatisfaction with practice, by 2009, we are likely to face even more problems with physician supply, exacerbated by the growth in demand.


The evolution to a more consumer-driven or consumer-centric health care system will greatly complicate the delivery and financing of care for health plans and health providers. But it is a force that will be very powerful and have its full impact during the coming five to ten years.

For example, individuals with employer sponsored health coverage will have more choices but will also be spending more of their money to have coverage. They will, of necessity, have to pay more attention to their decisions and require more information. They will also be confused if coverage remains as complicated as it is today.