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Thinking About 2030

June 2021 Vol 14, No 2 - Editorial
David B. Nash, MD, MBA
Editor-in-Chief, American Health & Drug Benefits, and Founding Dean Emeritus, Jefferson College of Population Health, Philadelphia, PA
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Someone once said, “There is no future in predicting the future.” I have always been interested in predictions about the future. My very first book, which was published in 1987, was titled Future Practice Alternatives in Medicine,1 wherein I described a future vision of the healthcare system that seems eerily prescient now. For example, the section titled “White Coat, Blue Collar” described a future of doctors working principally as employees in large organizations.

I can vividly remember, years before that book, reading the bestseller by Alvin Toffler and his wife Adelaide Farrell—Future Shock.2 Toffler outlined a world undergoing a revolution from an industrial society to a super-industrial society. He argued, very convincingly in my view, that the pace of change itself was overwhelming to people, and he popularized the term “information overload.” I was mesmerized by this book, and it had a profound influence on my own thinking about a future characterized by data, although I could not then imagine a web-enabled smartphone while in junior high school in the 1970s.

Fast-forward to today, it was therefore no accident that I was drawn to 2 recent reviews3,4 about a new book from a Wharton School (my alma mater) professor titled 2030: How Today’s Biggest Trends Will Collide and Reshape the Future of Everything.5

The first review article to catch my attention appeared, appropriately enough, in Wharton Magazine last fall.3 It was a short excerpt of the book by its author, Mauro Guillén. In the excerpt, Guillén focused on a clash of the middle class and the pivot of the clash from America to Asia.3 Although the review was interesting, it did not make me want to purchase and read the entire book.

Shortly later, a bona fide review was published in one of my favorite magazines, Corporate Board Member.4 In this review, Dan Bigman noted, “Think Covid-19 is disruptive, you ain’t seen nothing yet. But you will…and much sooner than you think.”4 Well, now I was hooked, and I had to read the entire book.

As a result, I would like to review with you, our readers, a few healthcare-related chapters in this fascinating book and highlight some key take-home messages for our field.

Although the entire book about 2030 is compelling, I was mostly drawn to chapter 2, which is titled “Gray Is the New Black.” This chapter describes a future characterized by tech-savvy senior citizens who postpone retirement, which will cause our society to rethink what it means to be “old” and “young.”5 First, let me provide some numbers and connect the data to our industry.

According to Guillén, and contrary to widespread belief, millennials are not the fastest-growing market segment in the world. Instead, the fastest-growing segment is the population older than 60 years, and by 2030, the world will have 400 million more people in this age-group, mostly in Europe, North America, and China.5 In the United States, this age-group includes the Baby Boomers and the Silent Generation (sometimes called the Greatest Generation). Because I just received my Medicare card, I was particularly interested in these details!

In chapter 2, Guillén contends, rightfully so in my mind, that we are “at the dawn of the age of the ‘gray market,’ one that is growing in spending power, especially in the emerging economies.”5 From a healthcare perspective, this is going to be a true challenge on multiple fronts. Guillén noted, “As the gray market emerges, healthcare, home care, assisted living, and other similar service industries will be poised to thrive in 2030.…But perhaps the most exciting opportunities lie within the quality-of-life space, which will benefit from creative and innovative solutions.”5

The “gray priorities” that are described in this chapter are what I found to be the most intriguing. Discretionary spending for this cohort will be characterized by an emphasis on healthcare services beyond medication and doctor visits—think here about yoga retreats, gyms and fitness (post–COVID-19 pandemic, of course), special discounts for seniors from retailers such as Nike, personal assistants, robotics for health, and untold others.

Most interesting, this discretionary spending beyond core health-related needs will be up to “twelve percentage points higher in Europe and Japan due to lower out-of-pocket health care costs.”5 In other words, outside of the United States, the gray generation will be spending even more on the aforementioned list of health-related quality-of-life purchases. Furthermore, “the average senior above 65 in the United States allocates 14 percent of spending to healthcare, while in the United Kingdom it’s less than 3 percent. That enables British seniors to spend twice as much proportionally on things such as apparel, restaurants, and travel.”5

I think there are at least 2 other key implications of the “gray wave” that are healthcare-related. One involves global companies that have grasped this demographic transition and have pivoted from industrial production to healthcare. Probably the best example here is the multinational firm, Philips. Many readers may think of Philips as making light bulbs and television sets, but even now, their medical division (which is heavily oriented to home health services and population health technology) accounts for approximately 66% of the company’s total corporate revenue.5

It is also likely that firms making sophisticated robots will enjoy rapid growth as seniors embrace the use of robots for household help, such as cleaning and shopping, as well as for activities of daily living, such as bathing and grooming. Robots will also be deployed to keep seniors company and thereby reduce loneliness, as has been well-described elsewhere.6

The other implication is related to the financial side of healthcare. The gray wave means that seniors will be spending large sums of money out of pocket for healthcare, and that new firms will evolve to handle this new type of spending. Guillén sees “all manner of financial intermediaries and ‘fintech’ start-ups competing for the gray market.”5

My experience says that large national for-profit healthcare companies, such as United Healthcare, will eventually own this space, manage the interest float for millions of seniors, and simultaneously provide them with investment options, advice, and other complex financial services. Healthcare delivery and healthcare financing at the family level will continue to converge.

As I think more about the take-home messages from this important book, I can reflect on some aspects of my own work. Building on my recent editorial from October/November 2020,7 I am consulting with numerous firms to bring healthcare to the home; remote patient monitoring is a burgeoning field, and the technology to deliver the services itself is expanding too. Another interesting company is AposHealth, which has created a nonsurgical approach to knee osteoarthritis with an innovative shoe. The company’s mantra is that gait is emerging as the next vital sign to monitor health. The gray wave has a lot of aches and pains!

Reading Guillén’s book transported me back to junior high school. This is not always a pleasant journey for sure, but for a moment I felt as if my entire future is ahead of me, and I was giddy with anticipation. To make a Medicare-eligible old professor giddy is a darn good outcome. I know you will enjoy this book, too.

As always, I am interested in your views about the gray wave. You can reach me via e-mail at This email address is being protected from spambots. You need JavaScript enabled to view it..


  1. Nash DB. Future Practice Alternatives in Medicine. New York, NY: Igaku-Shoin Medical Pub; 1987.
  2. Toffler A. Future Shock. New York, NY: Random House; 1970.
  3. Guillén M. Middle-class clash. Wharton Magazine. Fall/Winter 2020:30-32.
  4. Bigman D. The world in 2030. Corporate Board Member. Accessed May 20, 2021.
  5. Guillén MF. 2030: How Today’s Biggest Trends Will Collide and Reshape the Future of Everything. New York, NY: St Martin’s Press; 2020.
  6. Duncan DE. Talking to Robots: Tales from Our Human-Robot Futures. New York, NY: Dutton; 2019.
  7. Nash DB. Pandemic posting. Am Health Drug Benefits. 2020;13(5):182-183.
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Last modified: August 30, 2021