Healthcare for a Graying America

Winston Churchill: “Healthy citizens are the greatest asset any country can have.”

The Baby Boomer generation (born 1946-1964) in the United States for a long time has been recognized as the harbinger of the future when it comes to numerous predictions. When a drab color—gray—is used to identify a trend, optimism can quickly turn into pessimism. The graying of America and the graying of disabilities continue to be wrapped in a doom & gloom context. Moreover, the facts themselves are daunting from several perspectives:

• By 2030, all Baby Boomers will be over age 65.
• By 2030, older adults will constitute 21 % of the U.S. population.
• By 2035 and for the first time in history of America, 65+ year old Americans will outnumber those under 18 years old.

Graying of disabilities is a phrase used loosely to connote living longer than expected with a disability. Sometimes it refers to travelling along two paths but eventually ending up at the same destination: Path 1; Aging with a Disability and Path 2; Aging into a Disability. Individuals can experience a disability earlier in life before they reach old age (aging with), or they can develop disabilities after they reach old age (aging into). Unfortunately for many, the famous quote from Lewis Carroll’s “Alice in Wonderland” still rings true: “If you don't know where you want to go, then it doesn't matter which path you take.” Planning for the “gray” times ahead is mandatory if you want to enjoy your longevity by being as healthy and happy as possible.

This blog is being written at a time when healthcare is considered a political “hot potato.” No matter the methodology for delivering medical services, the way people are insured, or the amount of funds appropriated, all decisions made today likely will prove transitory and woefully inadequate at some point in the next 10-15 years.  Alas, things probably will get worse before they get better, depending upon how quickly the country changes directions to deal with the reality of a graying population and planning for the challenges that come with the greatest number of disabled patients in history.

Knowledge underpins all good decisions in terms of healthcare, enabling and encouraging a person to take personal responsibility on their journey to old age. This blog is designed to evoke questions about the decisions that everyone must face on this journey, decisions which will dramatically affect their lives and the lives of others. Hopefully, the information is more informative than depressing, and the future for aging Americans with disabilities can be painted mentally with a brighter color than gray.

The components that require consideration before being blended into the concept of aging with adequate healthcare form the substantive content of this blog.

Health Insurance

Brief History. Early precursors of what we know today as health insurance started in the 1800s e.g., sickness funds aimed at protecting income by paying medical bills at the organizational level.  Modern health insurance began in the 1930s during the Great Depression with Blue Cross (hospital) and Blue Shield (physician) plans. 

President Theodore (Teddy) Roosevelt served from 1901-09, during a period known historically as the progressive era. In a nutshell, he believed national strength was tied to public health. Neither he nor his successors for the next century and a quarter have been able to muster the political will of the nation to pass legislation that would cause all medical services to be delivered under a model we refer to today as universal healthcare.

American Medical Association (AMA).... As large numbers of baby boomers cross into old age, there will be greater demands for chronic health care and for meeting the special needs posed by the “graying of disability”—people with disabilities living longer than they did in centuries past.

Health Insurance Today.  If there is one industry that bases everything on the numbers, it is the health insurance industry, and it has been successful in interpreting those numbers to its advantage for almost a century. What individual health insurance plans will look like in a few years remains a mystery because plans will continue to morph based on changes in the delivery/dispensing of services in the healthcare industry. As extraordinarily expensive experimental treatments, currently available to a few, become demanded by-- and possibly made available to-- an entire aging population, healthcare costs could soar. The question of who will pay or share in paying those costs remains steeped in controversy. Will Artificial Intelligence (AI) and Quantum computers play a role in ameliorating the cost factor or in some other way come to the aid of disabled persons by providing access to the latest medical miracles? 

And of course, health insurance companies, viewed collectively as an industry or sector, enjoy deep pockets, simplistically defined as possessing cash reserves well beyond those of other sectors. They also love to crunch numbers. They already have begun to implement and innovate using current-generation technology while eagerly awaiting next-generation technology to generate more accurate morbidity tables. These are the tables that show the proportion of people expected to become sick or injured at different ages and more importantly to policyholders, the tables upon which they base their premiums.

Government Involvement. Progressives today pick up where Teddy left off by proposing a single-payer healthcare system wherein the federal government would finance healthcare for the entire population. Such involvement would include collecting revenue through taxes and paying all healthcare bills, even though medical services might still be delivered by private doctors and hospitals. Those who oppose universal healthcare continue to label it as some form of socialism. When it comes to health insurance, “free anything” i.e. an entitlement, finds little support among the vast majority of elected executive officials or within the halls of the U.S. Congress. The proponents of Medicare for All often brandish other programs for public consumption that continue to be viewed by the majority of citizens --in all age groups-- as socialistic in nature and somehow a threat to democracy. 

Social Security, on the other hand, no longer suffers the stigma of socialism, and without it, millions of older people would be forced to live in a world of hurt. Despite the uncertainty of its future, Baby Boomers and the very old of our nation will continue to depend upon Social Security because for many this is either their only source or a necessary supplementary source to pay for their healthcare needs not covered by their health insurance.

Franklin D. Roosevelt: The Social Security Act offers to all our citizens a workable and working method of meeting urgent present needs and of forestalling future need. It utilizes the familiar machinery of our Federal-State government to promote the common welfare and the economic stability of the Nation.

Medicaid. The number of individuals with disabilities enrolled in Medicaid may fit the same ratio (based on ever changing empirical data) used to compare the disabled as part of the total population of the country—1 in 4. Federal government data puts the total number of Medicaid enrollees in the 70-71 million range in 2025. Centers for Disease Control and Prevention (CDC) Data (2022-2025) also supports the 1 in 4 ratio (28.7%). Artificial Intelligence (AI) tells us the number of elderly/disabled participants in Medicaid hovers around 20%. Regardless of what numbers we accept today as definitive, the numbers will trend upwards as the population grays.

Anyone Satisfied with Their Health Insurance? Yes, if you believe a national poll published December 13, 2025, by NBC News, but as you might expect, the results of this poll do not provide useful empirical data on policy holders with disabilities. Nevertheless, it would be reasonable to assume that some, if not many, of those expressing satisfaction with their health insurance do, in fact, have a temporary or permanent disability whether they choose to think of themselves as disabled or not. A quick summary of the results of this poll follows:

• 82% of Americans say they are “satisfied” with their health care coverage.
• About a third of the 82% say they are “very satisfied” with their current coverage. 
• Older adults, defined as 65 or older, were the “most satisfied” -- 9 in 10. 
• 42% in the 65 or older age group reported being “very satisfied.”
• Roughly 9 in 10 of those who have public health insurance coverage through Medicare or Medicaid reported being “satisfied” with coverage.
• 77% of those with private health care coverage were “satisfied.”

This poll and other such polls in all likelihood reduce the pressure on elected officials to take immediate action on lots of health-related issues and more specifically, problems related to the massive number of disabled patients who will require medical services 10 years down the road. It is quite likely, if not probable, that among the 20% who are not satisfied with their coverage, there is a higher percentage of persons with one or more disabilities— more than 1 in 4.

The Scope of Healthcare

Martin Luther King, Jr.:  Of all the forms of inequality, injustice in health care is the most shocking and inhumane.

Healthcare is a multi-faceted topic that subsumes health insurance even though it seems logical to have examined this facet of healthcare in some depth before delving into the all-encompassing scope of healthcare.

Defining Healthcare. First of all, in the financial world, healthcare is an official sector that includes companies involved in pharmaceuticals, biotechnology, health care equipment and supplies, health care providers and services, and health care technology. Next, the U.S. Bureau of Labor Statistics (BLS) places healthcare and social assistance in a broader super sector -- Education and Health Services-- which includes establishments like ambulatory health care services, hospitals, and nursing care facilities. Finally, Healthcare and Public Health (HPH) identifies healthcare as a critical infrastructure sector that protects the nation from man-made disasters like terrorism and natural disasters like the widespread occurrence of infectious diseases/pandemics. Additionally, healthcare could also be considered a public-private partnership involving a wide range of entities from direct patient care providers to health information technology companies. 

Health Insurance Companies Act as a Safeguard. Health insurance companies, as discussed previously, also play a critical financial role in healthcare by working directly or tangentially with other health-related organizations in an attempt to provide financial protection against escalating medical costs. Since profits for the health insurance companies continue to be enormous using any financial metric, there is precious little reason for health insurance companies to promote or endorse gouging by any other entities in the healthcare arena, most notably pharmaceutical companies or hospitals. Thus, health insurance companies offer somewhat of a safeguard against escalating costs for medical services across the board in their sphere of influence. How this translates into reducing premiums paid by older disabled policy holders cannot be ascertained.  

Persons with Disabilities as Part of the Universal Healthcare Conversation. Persons with disabilities have been a consideration in universal healthcare debates for a long time, primarily because as patients it has been fairly easy to recognize the obvious, i.e., that they have continued to face significant barriers to equitable access, even after passage of the Americans with Disabilities Act (ADA) three and one-half decades ago. Some experts believe their inclusion and improving their lives in measurable ways would demonstrate success if and when a truly universal healthcare system was established. Discussions tended to highlight issues like financial hardship, inaccessible facilities, and a lack of skills among healthcare professionals to serve disabled patients as well as other diverse populations, e.g., patients with limited English proficiency. 

Even though the establishment of universal healthcare for all Americans in the next decade (or beyond) is highly unlikely, the inclusion of persons/patients with disabilities in the discussion has proven fruitful by prompting legislation at both the federal and state levels which has significantly improved the lives of the disabled, e.g., removing barriers and expanding accessibility. However, inaccessible facilities (physical/architectural) and a lack of providers skilled in communicating with people with various disabilities remain major hurdles with or without the adoption of universal healthcare.

Desirable Traits for Those Dealing with Older Disabled Patients. Patience, tolerance and empathy are often overlooked in the name of efficiency. Younger doctors, nurses, and staff need to know that these traits are very important to their older disabled patients. When some sort of physical or cognitive disability appears on the longevity continuum for a patient, healthcare professionals need to understand and accept the fact that older and/or disabled patients simply take longer to get from point A to point B and to successfully comply with basic instructions, e.g., positioning themselves on a test apparatus or an examination table. In many cases, the situation with regard to understanding and following directions is exacerbated because of the patient’s vision and/or hearing impairment. Healthcare professionals cannot simply resort to reading charts, dispensing drugs, and scheduling lab tests and procedures. The human element needs to remain a part of every patient encounter whether in-person or virtual.

Demand for Change. Big surprise, based on AI wisdom and readily available human resources research, millennials are bent on reshaping a significant part of the medical profession especially as related to the roles of doctors, nurses, and technicians by:  a) prioritizing their (millennials’) work-life balance; b) engaging in purpose-driven work; c) pursuing perpetual career development; and d) using primarily state-of-the-art technology/equipment & systems currently available or on the horizon in their respective specialties. 

At the moment, healthcare organizations are focusing on these priorities to attract and retain millennial professionals. Basing one’s opinion on the behavior observed among members of younger generations and among those who comprise the tail end of the Baby Boomer generation, it is difficult to surmise that members of Gen Z or Gen Alpha will be rushing to work in the medical field with an aspiration to improve the delivery of medical services to old folks with disabilities.  

Maybe concepts like civility and a modernized version of an appropriate bedside manner need to be introduced as part of the medical school curriculum and the med-tech training school curriculum over the next decade. Since nutrition has never made it into these curricula, manners and patience by whatever names, speaking realistically, probably have no chance....

Medical Workforce Shortages. There is already a shortage of geriatricians, primary care physicians trained in elder care, and case workers capable of directly handling the benefits and services to which older disabled patients are entitled by law. Gaps in medical services are even more evident for patients with one or more disabilities and/or chronic diseases (multimorbidity). According to AI, multimorbidity can include the co-occurrence of physical conditions like diabetes, heart failure, and arthritis, mental health conditions such as depression or anxiety, or combinations like high blood pressure and chronic pain. 

Experiencing multiple chronic conditions significantly increases the risk of functional decline in older patients, leading to greater difficulty with the Activities of Daily Living (ADLs) like bathing, dressing, and eating, and Instrumental ADLs (IADLs) such as shopping and cooking, which, in turn, impacts independent living and the overall quality of an older patient’s life. Data on persons with disabilities is often faulty or skewed because many people experiencing the “problems and inconveniences” enumerated in this paragraph either do not realize or choose to ignore that, in fact and in reality, they are disabled. This means they also do not contribute to the compilation of accurate data that could help all aging persons with disabilities, e.g. funding, based on statistics, of government programs at both the state and federal levels. 

Key Trends

Thomas Edison:  The doctor of the future will give no medicine but will instruct his patients in care of the human frame, in diet, and in the cause and prevention of disease.  

Persons with disabilities owe it to anyone they care about and/or depend upon, as well as themselves, to recognize changes and trends in healthcare, and they would be wise to track these trends, many of which are based on advances in technology.

Healthy Aging as an Imperative. Steps to good health & happiness for the aging may include taking advantage of new medications for weight loss, reducing consumption of fast, processed foods filled with grease and sugar, and early planning for their choice of residence when they face the need for medical assistance or assistance with the Activities of Daily Living (ADLs) around the clock. Many researchers throw in long term health care (LTC) insurance as an option when discussing residential options, but the truth is that LTC insurance is unaffordable for the average person. The health insurance carriers know, based on the facts at their disposal and the influence peddled by their lobbyists, that the escalating costs of medical services and assisted-living facilities will not likely abate in the next decade (or possibly for a much longer period), and they charge premiums accordingly for such policies based on this knowledge.

Accessibility. Federal regulations and state statutes have begun mandating accessibility to documents published by government entities starting with essential documents, often identified as “vital,” used when applying for benefits and services. Telehealth services should improve dramatically with enhanced accessibility standards finding their way into enforceable laws. A new rule under the ADA Title II requires state and local government entities with 50 or more personnel to make their web content and mobile applications accessible by April 24, 2026. The standard will be Web Content Accessibility Guidelines (WCAG) 2.1 Level AA. Some states, e.g. Colorado, have already passed and implemented statutes to ensure accessibility to documents used by local and state government entities for all of their citizens. These changes, from a positive perspective, also will enable and encourage the use of government-provided telehealth services as they evolve. 

Accessibility in the private sector presents the next frontier for the accessible movement. It benefits the commercial entities within the private sector to get on board with improving accessibility for their customers and clients. The “big picture” after further success in the private sector is a nation characterized as accessible to all.  Note: Specialized and adaptive tools used in future telehealth -- in both the public and private sectors -- will feature multimodal communication which infers going beyond text and incorporating images, sounds, and even gestures.

Some seasoned methods and practices will remain in use for the foreseeable future. The demand from the medical community for qualified sign language interpreters and real-time captioning services will continue to increase over the next decade as the population ages and providers of medical services become more oriented toward and more accustomed to caring for disabled patients. The sheer increase in the number of such patients will force healthcare providers to seek the services of outside organizations with skilled employees or robots to assist in communicating with their patients. Formal arrangements with these companies will require contracts to guarantee the ready availability of a human or some form of technology to perform these services either while the patient is in an office or participating in a telehealth/telemedicine session.

Telerehabilitation will make use of digital solutions for physical and cognitive rehabilitation. Wearable devices and Al are a combo that can assist patients with mobility impairments on a remote basis.

Advanced Assistive Technology may include brain/machine interfaces that enable patients to perform such acts as steering their wheelchair using only their mind. Science is on the cusp of discovering innovative, sophisticated remote care solutions and inventing support systems for disabled patients which would, in the past, have been thought possible only through a miracle.

The future of telehealth for persons aging “with” or “into” disabilities will be driven by AI and technological integration. This means gradually incorporating a mixture of digital tools like software, wearable devices, and the internet into the routines of daily life and normalizing remote patient monitoring and smart home environments. However, “who” pays for “what” remains the trillion-dollar question.

Wearable Devices in the workplace offer the opportunity for real-time physiological or environmental monitoring and the possibility of decreasing employer health costs while increasing employee well-being through participation in incentive programs. The Rocky Mountain ADA Center (ADA Region VIII) released a research report on December 9, 2025, entitled “Wearable Devices in the Workplace and the ADA,” which takes an in-depth look at a variety of issues associated with wearable devices. The introductory statement to this paragraph is based on this report.

Empirical data, when available, will help determine whether older employees might resist wearing the devices because they view this as an assault upon their privacy. While “wearable” is far removed from “implantable” (e.g., a chip in a pet or a pacemaker in a human) when it comes to devices, the mental factor of invading or intruding upon one’s privacy undoubtedly will come into play.  If the wearing of devices becomes mandatory in a particular workplace, legal challenges may ensue, allowing the courts to shape what the law should look like for wearable devices, e.g., determining the limits of what an employer can demand an employee with a disability to do. In a health setting in the private sector, e.g., in a doctor-patient relationship, many of the workplace issues surrounding wearable devices will not overlap, allowing for their widespread use, limited only by the choices made by the doctor and/or the patient.

Gene therapies are a reality. These therapies work by targeting the underlying genetic cause of the disease, often offering a potential cure or significant long-term relief. AI gene therapy is already used for some cancers and inherited heart conditions; moreover, major progress is expected in the next 5-10 years for additional cancer applications and for treatment of some of the more common heart problems. Some gene therapies for rare genetic diseases have reached multi-million-dollar price points for a one-time dose. At a cost of seven figures, no doubt accessibility and availability will be brought into question, especially by health insurers and advocates for the aging disabled.

Many Baby Boomers believed as a result of the end of the Cold War, they now had a better chance of living to old age; moreover, their belief was bolstered, if they were young at this point in history, because they mistakenly assumed that medical research/science would rid mankind of cancer, heart disease, and a host of other undesirable maladies which had reduced the lifespan of the previous generation – the Greatest Generation. Do we have a similar scenario—based on hope— developing?

If and when gene therapies become standard practice for the treatment of a multitude of diseases, will Baby Boomers, or the very old with disabilities, be allowed to partake in such treatments? They would no longer be asking to be evaluated as candidates for experimental treatments or for drugs not yet approved by the Federal Drug Administration (FDA) for distribution to the public. They merely would be patients asking for the same treatments available to younger patients as a standard practice. A rather perplexing issue since the unknowns outnumber the knowns at this point. Ethics and capitalism will once again encounter a conflict.

Closing Thoughts on the Importance of Good Healthcare. Most Americans alive today will have the opportunity to experience graying, but as an individual or cumulatively as a nation, we only know what this has meant in the past and at present. The graying of future generations could be very different because of today’s achievements in AI, gene therapy, and due to advancements in numerous other areas of science and technology. These achievements, at a minimum, provide us with a framework within which we are limited only by the frailties of our imagination when pondering over health and healthcare for the future. It is a pleasant mental exercise to think about all the possibilities for happiness in a longer and healthier life. The different generations of Americans alive today and every future generation can count on two immutable facts: 1) longer life spans require a combination of good healthcare and good genes; and 2) enjoying good health will remain the top priority for all humans for eternity.

Thank you to our guest blogger, Advisory Committee member Ron Arthur, the State Equal Opportunity Officer for the State of Colorado and ADA Title II Coordinator for the Colorado Department of Labor and Employment.