While local providers are upbeat, there is no avoiding the fact that the Affordable Care Act is having profound effects on rural health care, from patients to hospitals, especially on the Mendocino Coast.

But the ACA is not creating all the challenges, as representatives from Mendocino Coast District Hospital and Mendocino Coast Clinics made clear at a public health care forum hosted by the League of Women Voters of Mendocino County on Feb. 11 in Caspar. What they describe is a system being rapidly transformed by demographic, economic and policy changes that has everyone scrambling to understand and adjust to a new world of domestic health care even as the ACA is rolled out in California.

There is general agreement that many factors contribute to the current health care system turmoil. The question is, is the ACA the solution?

Doctors getting older, patients getting sicker

Wayne Allen, chief financial officer and interim CEO of Mendocino Coast District Hospital, presented data showing that our current system is broken.

Almost one quarter, (24.7 percent), of physicians nationally are 60 years old or older. In California the figure is slightly higher, at 29.2 percent. But at MCDH, 61.5 percent of the doctors are in that age group.

Meanwhile, the incidence of chronic diseases is increasing. Worse, a lot of patients with these illnesses are here. From 44 to 49 percent of adults in Mendocino County have one or more chronic illnesses, according to a California Health Care Foundation graphic that Allen displayed.

Then there are costs.

Nine percent of Americans were enrolled in Medicare in 1965. In 2011, that number increased to 16 percent. We also spend four times as much treating persons over 80 years of age compared to the U.K., Germany, Sweden and Spain.

Yet, in a country that spends so much on health care, 47 percent of Americans were uninsured in 2013. The number is attributable to rising costs to treat the sick and a recession that combined to put health insurance out of reach for many.

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Health care transition pains coast