The Three Horsemen of the Coming Healthcare Apocalypse

Ok, so not really – It’s not about horsemen, it’s already partially here, and it won’t be an apocalypse either. It is however going to be a very big problem, it’s going to bankrupt some people, destroy some industries, and it’s going to put a massive hurt on almost everybody for many decades to come.

There are three healthcare issues that interact with each other, and which would have been a huge problem individually, but are going to slap us hard across the face when put together. I am talking about the Aging Population, Obesity, and Climate Change.

Aging Population

Here’s the thing. 10,000 Boomers are retiring per day, they did a horrible job of preparing the next generation to take the helm, and there are fewer of the next generation to do so anyway. We already have a looming shortage of nurses and doctors and medical technicians, and when a bolus of them retire and need medical help, we simply won’t have enough replacements to take care of the aging population. If your organization didn’t have a knowledge management, and training and recruitment plan already in motion ten years ago, the bottom line is that it’s too late. The chances are that you won’t save your organization from collapsing, and the best you can do is arrange a slightly more elegant landing than a straight-up belly flop from the highest diving board.

The medical schools have been focused on keeping profits high, the APA on keeping competition down, and who in heck knows what legislators were doing. Probably nothing. Maybe just pulling practical jokes on each other. So we have let the Magic Sparkle Fairy of the Invisible Market and siloed interests and perverse incentives drive how we scaled, staffed, and recruited for medical schools, and we are going to be massively, monstrously, marvelously short. We are already short, and it gets worse.

We are going to have the same problem across every part of healthcare, and our normal go-to plan of stealing skills from other countries isn’t going to work because they have the same problems.

That was the good news.

The bad news is it’s going to be much, much, much worse than I said. We didn’t invest in the infrastructure or save for this either, so this is going to be a huge, nasty drag on getting anything done in healthcare.


The entire world is getting heavier, and the US is one of those leading the charge. I mean of course the people are getting heavier. All ages, all genders, all races. All income groups. Some a bit more than others, but all of them are slowly getting heavier. Actually, not so slowly. Kinda fast. In fact, very fast – the rate has doubled globally since 1980. Obesity is now something that 35% of Americans can call their own, and the number is climbing.

With obesity comes a rapid increase in a whole raft of medical conditions, including diabetes, coronary disease, cancer, depression, and so on. All of them very expensive, chronic, and thoroughly entangled in social determinants of health and perverse incentives. One example is that we subsidize corn production. That creates cheap corn syrup. Corn syrup is added to every food and drink imaginable. It contributes to obesity, diabetes, stroke, and tooth decay. Wonderful stuff. So we fund a thing that kills us. Wonderful. We do that a lot.

We have entire industries whose focus is to craft very unhealthy food that is very appealing to our instincts, the way our brains work, and are kinda habit forming. The more money they make, the sicker we get, and they like making more money.

Climate Change

Despite Congress being really conflicted over whether it is happening, whether we are causing it, whether it is more important to bring out tortuous laws about gender assignment and public restrooms, Climate Change is increasingly a topic in healthcare. The anticipated effects of Climate Change of healthcare can be seen in research papers, conference sessions, and lectures at medical schools. The news isn’t very good. Well, actually not “good” as much as really bad.

There is almost no healthcare problem that is not made worse by Climate Change. On its own, Climate Change would be a darned pest. It will disrupt the agricultural supply chains, submerge some of our business transport links and cities, and increase damage to infrastructure through storm surges, hurricanes, tornados, and other forms of interesting peak weather. However, that’s just the entertaining stuff. It will also lead to resurgence of old medical enemies, shift vendors into novel regions, and hike up emergency visits for everything from asthma to zoonotic infections.


So even together these three aren’t an apocalypse, and won’t end the planet, our species, or even halt the amount of sports we watch. From the couch. With a Big Mac and Fries. And a soda. A big one. The super-slurp one that’s five times the size of our bladders and has enough corn syrup to kill off a platoon of insulin-producing beta cells. Not an apocalypse.

While it won’t be an apocalypse, each one will be a bit like getting a backhander through the face. On a cold morning. With a fish. A large wet fish. The three together will be like getting three individual fishy-slaps through the face, followed by another, bigger fish. With spines and slime. And frozen. A hearty backhander though the face on a cold morning with a large frozen fish, wielded by an Olympic medalist in fish throwing.

A bit like that.

Are you ready?

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4 Responses to “The Three Horsemen of the Coming Healthcare Apocalypse”

  1. robc0450 Says:

    Hi Matthew,
    As a boomer who is tentatively considering retirement in South Africa, I have to factor in the impact of the Zumafication of our economy and its potential to follow Zimbabwe’s example.
    I had almost plucked up the courage to take the plunge (into retirement) until I saw this article.
    Then again, you seem to be suggesting that we’re stuffed already, so what’s the point of worrying?
    We might as well continue to live for the moment.
    Regards, Rob.

    • Matthew Loxton Says:

      Well we probably are just a little stuffed, but that’s at the population health level. Individually, things look slightly better though. If you as an individual take care to keep weight under control, avoid tobacco, fast food, and stress, and get in 250 steps per hour, etc. your outlook could be quite good.

      There isn’t much we can do to stop aging, and its long past time to have planned for workforce replacement, but we can still limit obesity and the worst scenarios in climate change.
      However, if you live on a small low lying island and already obese, things ate pretty dismal.

  2. rob jones Says:

    Excellent post, Matthew. For healthcare broadly, I see the perfect wave of challenges as, 1) aging, 2) income inequality, and 3) shrinking pool of professionals. The diversity overlay creates a level of complexity that boggles the mind. Mine, anyway. However, the health implications of global climate change are more like emptying a gasoline tanker onto the perfect wave, and then surfing that wave on a papier-mâché board while smoking a huge cigar and flicking the embers and ashes into the sea. Hugging a good frozen mackerel would feel pretty good about then.

    • Matthew Loxton Says:

      Hi Rob@
      Yes, good point, income inequality creates a whole other dimension, and drives a LOT of the social determinants of health. Income inequality may be a significant driver of obesity in low SES populations. It certainly is a big factor in ED admission and read mission rates.

      Thanks for the imagery too, I quite agree.

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