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There are interconnected trends that are shaping twenty-first-century medicine: the movements toward large group practices, collaboration, use of big data, innovation, better patient experience, wellness and integrated care, and personalized medicine. Our healthcare system has the potential to be much better, more efficient, and more affordable than it is today. We have it in our power to make healthcare work, but for that to happen, we need to push these trends further—as professionals, as patients, and as Americans. We need to make healthcare bigger and more efficient, but simultaneously smaller, more intimate, more personal, and more suited to the individual patient, so that it serves us well and delivers value.

American medicine stands at a crossroads. Questions about finance, regulation, and the organization of medical services hover at the forefront of our national discussion. How we answer these questions will affect the lives and health of millions of people in the years to come. We face major challenges, yet I feel strongly optimistic about the future of healthcare in America.

Society faces a public health crisis of unimaginable proportions in the coming years. Breakthroughs in the treatment of infectious diseases, improvements in public health, and continuing innovation in cardiac surgery, orthopedics, stroke treatment, and emergency care have allowed Americans to live longer than ever. Fewer people are dying young of heart attacks, polio, measles, or pneumonia, but now our hospitals and medical centers are filling up with a whole set of different and, in many ways, more stubborn disease conditions. Three factors are driving this.

A Rapidly Aging Population

According to the Administration on Aging, more than 40 million Americans are currently aged 65 or older. By 2030, the number of Americans who are over 65 will have more than doubled from their number in 2000, to almost 20 percent of the population. Among today's older adults, most have at least one chronic disease, and at least one in four has two or more. The world financial crisis of 2008 and other factors make it likely that our older demographic will be an increasingly poorer demographic. Poverty will raise older people's already high risk for disease and disability and shift the cost of care almost entirely from the individual to society.

Preventable Diseases

Smoking, overuse of alcohol, poor diet, lack of physical activity, and chronic anxiety are promoting some of the most serious, destructive, and expensive diseases that we treat. Type 2 diabetes, hypertension, cardiovascular disease, and many types of cancer are not mysterious diseases that come out of nowhere. They are largely caused by our own lifestyle choices. Most people have at least a vague understanding of the cause-and-effect relationship between lifestyle and disease, but they lack the self-discipline or motivation to change their behavior.

Diseases of the Aging Brain

Advances in medicine are helping ...

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