Do demographics determine destiny? Sometimes. No doubt, America is definitely getting older. This growing wave of the gray heads may not trigger an avalanche of events, but in the case of Medicare, it signals some worrisome trends. Consider:

• Everyday, 10,000 baby boomers celebrate their 65th birthday and become eligible for Medicare.

• The Medicare program currently costs about $560 billion annually and covers more than 48 million people. The Congressional Budget Office projects Medicare costs will total more than $1 trillion by 2022.

• The ratio of workers to beneficiaries declined from four workers per beneficiary in 1965 to slightly fewer than three workers per beneficiary in 2011, and will be two workers per beneficiary in 2040.

• The average couple will receive $387,000 in Medicare benefits, but only pay $122,000 in Medicare taxes over their lifetimes.

A recently released publication by the American Hospital Association, "Ensuring a Healthier Tomorrow: Actions to Strengthen Our Health Care System and Our Nation's Finances," concludes that these demographic shifts and trends create a significant — and unsustainable — burden for future generations. And that, "If health care spending is not slowed, the effects will be profound and affect everyone — health care providers, the government, insurers and employers, and individuals." It puts forth two strategies and six priority recommendations for each strategy. (You can read the publication at

One of the key words here is "everyone." To say that health care delivery is an immensely complex undertaking is the understatement of the decade. The "system" itself comprises numerous interrelated and interdependent parties and entities. I think it's a safe bet to assume that if health care is a multifaceted problem, then it has a multifaceted solution.

Hospitals and physicians are a very big and important part of the delivery system, which garners a lot of attention, but we are not sole players. The entire cast is huge and influential. Both state and federal governments, insurers, employers and individuals all play major roles in making the system operate better and more efficiently for patients, but so do all the numerous very large industries, vendors, agencies and service components whose core business is health care. We're all in this together and everyone must contribute to the solution.

And not to be all rah, rah hospitals, but, as the old saying goes, 'Give credit where credit is due.' Heaven knows there are problems, but many hospitals have made significant progress in reshaping how care is delivered to patients. The focus on the continuum of care is one of the best aspects — and most helpful to patients — of recent times. Many health care organizations also are participating in Hospital Engagement Networks and independent efforts to make care safer and more efficient. Many others are forming innovative collaborations with insurers, employers and others that facilitate population health. All of this is real and exciting and unlike any other period in health care. Now, as Benjamin Chu, M.D., AHA's new board chairman, says in this issue's Interview, "We have to give time for those changes to take hold." Let's hope transformation doesn't end up getting shortchanged.

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