The Thirty Years Perspective

Thirty years is a long time.  I was reminded of that by two things: the 30th anniversary of Tim Berners-Lee conceiving the World Wide Web (March 12.1989), and a new report from the Pew Research Center asking Americans about our country in 2050.  Thinking about the former helps me think about the latter.

They make me wonder about healthcare in 2050.

Let's start with the birth of the World Wide Web.  The internet existed, but it was not widely dispersed.  Services like Compuserve or Prodigy gave glimpses of what online life might look like in the future, although dial-up speeds and the closed nature of those communities limited those glimpses.  Tim Berners-Lee (and a few others) imagined a different future, and, amazingly, his scribbled diagram came to fruition.

Tim Berners-Lee original sketch.  Source: w3.org

If you were alive in 1989, would you have expected that by 2019 you could always be in contact with almost anyone, find out almost any fact, read or watch almost any content, and buy almost anything?   Most of us would probably have to say no.

It certainly is no exaggeration that the advent of the World Wide Web, spurred by broadband and mobile, has greatly impacted the lives of most of the people in the world. 

What I find most striking is to think about the changes in largest companies in the world, and how the World Wide Web helped bring them about.  Back in 1989, 7 of the top 10 companies were Japanese, and most of those were banks.  As of the end of 2018, 5 of the 10 largest companies by market cap were internet-based companies -- Alibaba, Alphabet, Amazon, Facebook, and Tencent -- started after 1989 (and, in most cases, after 1999), while another two of the top 5 -- Apple and Microsoft -- used it to greatly boost their size. 

A new technology changed the landscape of our lives, and our economy. 

-------

Let's turn now to the Pew report.  It would seem that Americans don't have high hopes for our country's future.  For example:

• 87% are worried our political leaders won't be up to solving our biggest problems;
• 60% think America will be less important in the world;
• 73% think the gap between rich and poor will grow;
• 72% think older Americans will be less prepared financially for retirement;
• 65% think we'll be more politically divided;
• 59% think the environment will be worse;
• 44% think the average families' standard of living will get worse (only 20% think it will be better).  

We look to science and technology (87%) and education (75%) to help us solve our problems, but we don't list spending on science as a very high priority (34%) and about three-quarters worry about the quality of public education.  In other words, we'll need other countries -- or magic -- to help us. 

When it comes to healthcare, 58% think it will be less affordable in 2050.  Providing "high quality, affordable health care to all" is by far our top priority (68%) to improve the quality of life for future generations, although we aren't very confident we will. 

----------

Using the lessons of the last 30 years, here are a few predictions about the next 30 years:

New technology: As much as we worry about the size and influence of today's Big Tech, it is very likely that few, if any, of them will be the largest corporations in 2050.  Pick almost any thirty year period and it is amazing how much that list changes from beginning to end.

Some new technology will come along to revamp our economy.  Many of the new corporate leaders will use it.  Moreover, that technology probably exists, in formative or early stage development, right now.  The hard part is figuring out which one it will be, and the second hardest part is predicting how that technology will be adopted.

Healthcare system:  Thirty years ago we did not have universal healthcare.  Thirty years ago the biggest types of health care spending were on hospitals, physicians, and prescription drugs.  Today we still do not have universal healthcare, although ACA put a dent in the number of uninsured, and the biggest types of healthcare spending remain hospitals, physicians, and prescription drugs. 

A healthcare encounter today looks very much like a healthcare encounter of thirty years ago, although with more electronics -- and much more expensive. 

Given the level of political polarization, and our lack of faith it will get any better, I don't have much confidence that we'll have achieved universal coverage even by 2050.  That healthcare encounter, though, is something we should hope will radically change. 

Rethinking health:  Pouring more money into our current healthcare system is not likely to make us healthier.  Spending more on the traditional sources of care is not going to revamp our care or when we need it.  If we're still going to the hospital, going to a doctor's office, or taking a prescription drug in 2050 at anywhere near the rates we do in 2019, then we will have failed.

What we need are technologies that change the healthcare economy in the way the World Wide Web changed the global economy from 1989 to 2019.  Technologies that bring new entrants, doing new things.  Those technologies and the things that are done with them may be aimed directly at our health, or may just have better health as a nice side effect.

Credit: body>data>space

For example, the new health technology might revolve around the fusion of biology and electronics.  That might include the so-called "Internet of the Body," using DNA for data storage and computing, and cell-sized robots and devices. 

These kinds of technologies already exist; it just remains to see what we can do with them.

------

In 2050, I hope that healthcare is a much smaller portion of our economy.  I hope that by then we focus more on maintaining health than we do having the healthcare system fix health issues.  I hope that the next Facebook or Google or Apple has something to do with our health, in a way that delights us and on which we'll gladly spend our own money. 

What technology or technologies would make our current healthcare system seem as old-fashioned as the pre-World Wide Web world?