If you listen only to the national political debate on healthcare you would believe that we are headed inevitably toward some form of universal, nationally controlled system of care.
However, the federal government has not and will not lead the essential changes required in the industry. The political environment and politicians’ dependencies on historical campaign funding from healthcare industry donors will cause congressional behavior to continue, as it has, making small incremental change. This behavior every year simply reinforces the existing system.
Dramatic, fundamental change by government action will not be forthcoming for three reasons. First, there is no feasible funding plan for “Medicare for All.” Second, 150 million U.S. citizens are not going to accept having their current healthcare insurances and providers changed. Third, the fundamental solutions for healthcare are reducing cost and inappropriate utilization. Adding money to the healthcare system to cover uninsured persons is irrational when we have plenty of money already in the system to cover everyone today.
So, if you step back and examine healthcare industry trends the following four factors will be principal drivers of change in 2020:
1. Employers are frustrated with the government, commercial insurers and healthcare providers for not solving the financial issues of an overbuilt system. Angered employers will be the principal actors driving healthcare change in the commercial sector. Action by leading national employers (notably Walmart’s health benefits strategy) will be replicated by other employers and, over time, their collective efforts will generate a national effect:
2. Insurers will continue their efforts to reposition as providers. For example, Optumcare owned by UnitedHealthcare and entities like them will expand their capabilities as direct care of providers (e.g., physical therapy, home care, urgent are, ambulatory surgery, etc.). As a result, hospitals will become providers of reasonably priced inpatient care.
3. Costs and utilization will radically be reduced:
4. The pace of change will accelerate. Unfortunately, most provider entities are inhibited by their existing organizational process and practice, unable to match the pace essential to compete.
Take another look at these predictions in January 2021 and see whether they are reflected in what actually happens.