The American Dream Is Turning Into a Sick Care Nightmare

that the share of young Americans overall who said the American Dream "is not really alive" grew sharply from 12% to 29%. Among white people, it nearly tripled from 10% to 29%. One in three white non-college graduates now say it is not alive, compared to one-fifth of white college graduates; the increase from 1986 was larger for non-graduates than for graduates.

Overlay that with the observation that the large majority of outcomes have socioeconomic and educational determinants, and, well, you can see where we are headed. Without fixing the problem of economic and wage stagnation and educational gaps, the Sick Care cost curve will continue to be the monster that devoured our federal budget. What are some solutions?

1. Relentless migration to a patient-centric model.

2. Reformation of medical education and training.

3. Reassessing and penalizing hospitals that get tax breaks but don't meet competency benchmarks in serving their communities outside of their walls.

4. Finding better ways to raise the health and insurance IQs of patients, particularly those in the 99%.

5. Shifting funding from Sick Care (88%) to disease prevention and wellness.

6. Changing the reimbursement rules.

7. Extending HIT interoperability to socioeconomic system components, not just traditional and alternative points of care.

8. Creating better ways to integrate and make more coherent Sick Care, education, and economic reforms.

9. Addressing the medical student and trainee crisis in confidence i.e. that the practice of medicine will make them happy and help them realize the American Dream, particularly for underrepresented populations.

10. Changing Sick Care to healthcare. Here are 10 ways to do that.

If we fail to address these challenges soon, the result will be escalating costs, damage to population health, and continuing political and social disharmony. The solutions are emerging, but doctors and patients need to increase their clock speed.