A former politically savvy county judge in Fort Worth reportedly once told a group of ambulance providers who were loudly opposing a new regional emergency medical authority designed to enhance service and improve quality: The train is on the tracks. You are either on the train, or on the tracks.

I have used that story before. I am dragging it out again because it accurately reflects where we are in healthcare: The Medicare program as we know it today is on a collision course with the U.S. financial crisis.

In healthcare, the train represents said financial crisis and the profound impact that it will have on government spending for healthcare services at a time when there is an avalanche of new beneficiaries entering the program – one every 8 seconds, according to USA Today. Over the next 18 years, Medicare’s ranks — those who qualify for government healthcare — will increase by more than 40 million people, even when factoring in deaths, analysts estimate.

Currently, we are borrowing about 30 cents on every dollar paid to physicians, hospitals and other healthcare providers for Medicare services.

Now, add these numbers to the mix: The current annual deficit is about $1.27 trillion as of midnight last night (02/09/2012). The national debt is more than $15.3 trillion.

What is the difference between the deficit and the debt?

The deficit is the annual shortfall of revenue to spending. The national debt is the sum of all outstanding debt owed by the Federal Government. Nearly two-thirds is the public debt, which is owed to the people, businesses and foreign governments who bought Treasury bills, notes, and bonds. The rest is owed by the government to itself, and is held as Government Account securities. Most of this is owed to Social Security and other trust funds, which were running surpluses. These securities are a promise to repay these funds to Baby Boomers as they retire over the next 20 years. For now, they are unfunded liabilities. These unfunded liabilities represent a substantial sum that the federal government has NOT included in its debt calculation. Everyone in Washington knows about this, including all the Presidential candidates, and yet no one is talks about it.

In business, corporations are required to count these unfunded liabilities when they are taken on — and report a big loss to shareholders. Unlike businesses, however, Congress postpones recording spending commitments until it writes a check. Those are the promises made for future payments in Social Security, veterans’ benefits, government retirement, healthcare for senior citizens, etc.

If the deficit and debt numbers scare you, then the amount of unfunded liabilities — the government’s “off balance sheet” debt — will drive you off a cliff. That number is about $61 trillion, USA Today reported. These “unfunded obligations amounts to $528,000 per household. That’s more than five times what Americans have borrowed for everything else — mortgages, car loans and other debt. It reflects the challenge as the number of retirees soars over the next 20 years and seniors try to collect on those spending promises.”

The deficit, the debt, the unfunded liabilities – those are numbers so big that it is hard to get our arms around the extent of the problem. So, lets cut it back to a basic number we can deal with. How much is a $1 trillion?

The most graphic way to understand the size of this number is to use a time analogy.

If you started spending $1 million a day, every day, from 1 AD when Jesus Christ was born, through midnight last night (2/9/2012), you would still have about a quarter of a billion dollars left.

That is how big, how bad the $1 trillion number is. But remember, our national debt is now more than $15.3 trillion. Now think about the speed with which the government is incurring new liability — the Baby Boomers who qualify for Medicare coverage at the rate of one every eight seconds.

Do you see the train? Can you begin to imagine how messy this collision will be?

There are way too many leaders who bristle when you suggest that the healthcare industry that we know today will be substantially different over the next five to 10 years. It will never happen, they argue, the voters will never allow it.

When I hear that argument, two things come to mind: the newspaper industry and the Greek government.

These dramatic changes may come incrementally, allowing us some time to adjust. Or the European debt crisis could ignite a global disruption in the credit markets. No one can be sure when or how fast this financial catastrophe waiting in the wings will occur. I do know one thing for sure: the train is on the tracks.

Today’s career management tip: now is the least embarrassing time to learn how to adjust to dramatic change.

Sorry, perhaps I should not joke about something this bad.

© 2012 John Gregory Self