What’s the New “Golden Gate Bridge” in the U.S. Healthcare System’s Future?

May 20, 2020

Human beings have always aspired to conquer challenges. Look at the history of San Francisco’s Golden Gate Bridge, which, after decades of vision, discussion, planning, funding, and hard work, finally became a reality in May 1937.

As History.com explains it, “Following the Gold Rush boom that began in 1849, speculators realized the land north of San Francisco Bay would increase in value in direct proportion to its accessibility to the city. Soon, a plan was hatched to build a bridge that would span the Golden Gate, a narrow, 400-foot-deep strait that serves as the mouth of the San Francisco Bay, connecting the San Francisco Peninsula with the southern end of Marin County. Although the idea went back as far as 1869, the proposal took root in 1916. A former engineering student, James Wilkins, working as a journalist with the San Francisco Bulletin, called for a suspension bridge with a center span of 3,000 feet, nearly twice the length of any in existence. Wilkins’ idea was estimated to cost an astounding $100 million. So, San Francisco’s city engineer, Michael M. O’Shaughnessy (he’s also credited with coming up with the name Golden Gate Bridge), began asking bridge engineers whether they could do it for less.

As History.com notes, “Eventually, O’Shaughnessy and [engineer Joseph] Strauss concluded they could build a pure suspension bridge within a practical range of $25-30 million with a main span at least 4,000 feet. The construction plan still faced opposition, including litigation, from many sources. By the time most of the obstacles were cleared, the Great Depression of 1929 had begun; but, “[I]n the end, it cost $35 million to build the bridge ($514 million in contemporary dollars), and it took four years and four months to build it, with thousands of construction workers involved (and 11 deaths from falls).” But the Bridge’s completion created great excitement, and beyond its 20 million southbound crossings every day, the Bridge has also become a beloved worldwide symbol of San Francisco. But it’s clear that simply imagining the Bridge was not enough; it took tremendous vision, planning, money, and hard work to make it a reality.

Some of the same types of challenges face the U.S. healthcare delivery system right now, as we lurch into the second decade of the 21st century. The payers, purchasers, and consumers of healthcare have long been demanding that the providers of care—hospitals, medical groups, health systems, and post-acute and ambulatory care providers—deliver higher-quality, more reliable care, at lower costs, even as our society faces a double problem of aging and continuous increase in chronic illness. As the Medicare actuaries have noted, total U.S. healthcare expenditures are expected to increase from the current $3.3 trillion to nearly $6 trillion per year—a full 61 percent—in the next seven years. And all of that was before the extraordinary clinical, care delivery, operational, and financial challenges that have come with the COVID-19 crisis.

And it is in the middle of this crisis that we at Healthcare Innovation are pleased to present our Ten Transformative Trends, our annual review of the most important trends influencing the U.S. healthcare delivery system. In the midst of the enormous challenges brought on by the pandemic, innovation and transformative change are continuing forward. Transformative change will require the same type of ingenuity and hard work that went into the building of the Golden Gate Bridge. But meaningful progress is absolutely possible. The proof? On a clear evening, as one looks west from the city of San Francisco, through the Golden Gate, nothing human-made on earth could be more inspiring than The Bridge.

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