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America’s Healthcare System – Part 12
Exploiting Future Opportunities for Reforming the US Healthcare System
This is the 12th essay in Civic Way’s series on the US healthcare sector. In this essay, we discuss some future developments that could disrupt the healthcare sector and yield promising opportunities for reforming American healthcare. The author, Bob Melville, is the founder of Civic Way, a nonprofit dedicated to good government, and a management consultant with over 45 years of experience improving public agencies.
As every president from Truman to Clinton has learned, the interests that dominate our sprawling, wasteful healthcare sector have the will, wealth and weapons to preserve the status quo
While reform seems impractical in today’s environment, unanticipated—yet decisive—events could free us to reinvent the US healthcare system (if we seize upon the opportunity they afford us).
There are several events or trends that could sufficiently disrupt the healthcare sector—or precipitate its collapse—and thereby make it possible to reinvent or reform healthcare.
If such an opportunity arises, however, it will not be there forever. To seize the opportunity, we will need a draft agenda to debate, refine and implement, an agenda we must start forging now.
Every year, Americans pay twice as much for healthcare as citizens of our peer nations. Given how much we spend, we would be right to expect far better health outcomes than other nations. Sadly, our outcomes are worse, and the gap between the US and our peers is worsening by the year.
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This dilemma has many causes. Too little prevention (and public health capacity). Uneven care access and quality. Fragmented resources. An ill-conceived financing (insurance) system. Profit-driven—not people-driven—innovation. Antiquated administrative systems. Each factor has been covered in prior essays.
In the next two (and final) essays on US healthcare, we will outline some short-term and long-term strategies for building an integrated healthcare system worthy of our nation. In this essay, we discuss some future trends and developments that could destabilize the healthcare sector and, by doing so, provide unanticipated opportunities for facilitating previously impractical reform strategies.
The Political Realities of Healthcare Reform
As we learned during the passage of the ACA—perhaps even more so during its aftermath and the countless repeal efforts—there may be no political battle more perilous than reforming American healthcare. As every president from Truman to Clinton has learned, our politics are no match for the intractable healthcare issue.
Healthcare is the US economy’s biggest sector. No matter how inequitable, inaccessible, or wasteful it gets, it stubbornly resists serious reform. Its many principals—insurers, hospital systems, physicians, other providers, Big Pharma and medical device manufacturers—share one overarching goal, to preserve the status quo. And these groups possess the will, wealth and weapons to attain that goal.
In turn, most politicians today lack the capacity (and courage) to challenge these powerful interests. It doesn’t help that reforming healthcare offers far more political risk than reward. Funding campaigns and winning elections require politicians to malign their opponents not solve problems. So they demagogue good faith healthcare reform efforts and trade accusations—folly, cruelty, socialism. Instead of debate and compromise, they deliver polarization and inertia. They defer solutions and leave the problem for the next generation.
The Opportunities of Future Disruption
Reforming healthcare will be hard, if not impossible, especially if reforms must occur in a static environment. When we envision reform through today’s lens, we condemn ourselves to frustrated resignation. We accept that the beneficiaries of the status quo—and the lobbyists they employ—will never succumb to conventional tactics or thinking.
But what if that landscape changes? What if the healthcare sector’s natural order is disturbed or the current balance of power among insurers and providers shaken? What if something occurs that is so destabilizing to the healthcare industry that—at least for a moment—enduring, structural reforms become possible?
History is replete with such disruptions. We may not know precisely what they will entail, who they will impact or when they will come, but we do sense their inevitability. Their particulars may be hazy, but transformational disruptions can offer fortuitous opportunities for sweeping and once unimaginable change.
We need only look beyond today’s reality, beyond what seems immutable. When we do that, we might find the obvious barriers to healthcare reform a bit less intimidating. A little more scalable. We might just visualize a moment when the impossibilities of healthcare reform become possibilities.
Future Trends That Could Transform Healthcare
What are some of the developments that could significantly disrupt the healthcare sector? And how might they affect healthcare? More importantly, how might they impart opportunities for reform that our current dysfunctional politics cannot? Here are just ten trends to watch.
Demographic – Growth usually means more healthcare demands. An older population means more patients. More diversity means more demands for more equitable (if not individualized) service.
Economic – Greater healthcare market consolidation could hurt competition, efficiency and quality. Small solo hospitals, physician practices and pharmacies could disappear. Giants like CVS Health, UnitedHealth and Walgreens could dominate healthcare policy, financing and innovation even more than now.
Medical – Relentless profit pressures for insurers, pharmaceutical firms and providers could accelerate new care strategies, such as telehealth, expanded nonphysician roles, and more efficient, data-driven and outcome-focused treatment for common diseases.
Labor – If worker shortages persist, providers may restructure compensation, give employees more control over working conditions and leverage new technology to automate tasks.
Service – As healthcare consumers demand more convenient, equitable service from healthcare providers, more providers could offer more responsive service like home care and 24x7 customer support.
Insurance – If employers start offering employees defined contribution plans, they could force insurers to expand offerings (e.g., plans that enable individuals to choose more convenient providers).
Technology – Many innovations will benefit specialized fields. But other innovations could facilitate more universal care models. Computer assisted diagnosis. Wearable medical devices. Telehealth. Less invasive imaging and procedures. Putting patients first could dramatically healthcare delivery.
Self-care – As healthcare becomes less affordable and accessible, and health data more useful, we could choose healthier diets and lifestyles to prevent illness. We could access better data to improve diagnoses and determine care needs. We could use provider ratings to better match needs with providers.
Public health – Big data analytics and bigger public health programs could prevent many chronic illnesses and improve health outcomes, but another global pandemic (coupled with dysfunctional politics and inadequate pandemic preparedness) could overwhelm our fragmented healthcare system.
Records management – Seamlessly linking electronic medical records to diagnosis, best practice data, treatment analysis and billing could improve patient care quality and efficiency.
Just one of these trends could significantly change the environment in which healthcare is delivered. If and when that happens, we could have a rare opportunity for healthcare reform.
Could Healthcare Reform Become Inevitable?
Believe it or not, the status quo could become so intolerable that reform is no longer an option. And incremental government initiatives might only postpone the inevitable.
For every year without reform, the healthcare system’s collapse could become more likely. Pressures on patients, providers and insurers could become unbearable. Rising costs. Unstable health insurance markets. More uninsured and underinsured people (including the middle class). A growing chasm between affordable and unaffordable care. Hospital closures. Worker shortages. Healthcare deserts.
A disruption or collapse could trigger reform, but the reform window—the time before the status quo defenders regroup—will close quickly. To exploit that opening, we will need a blueprint for reform to pull off the shelf, circulate broadly, review carefully, refine collaboratively and implement.
The time to forge that agenda is now. Compile the best ideas from think tanks, universities, associations, and advocacy groups. Synthesize those ideas into a single cohesive agenda for reforming healthcare.
It may be that only by starting now—when reform seems so unrealistic—that we will ultimately have a chance to reform healthcare.
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