April 16, 2012

The Long Road From March to November

Preface:  The following Medinnovation post was recently reprinted in The Health Care Blog,  a widely read blog.

No one knows what will happen between now and the election. But whatever occurs, it will be a psychological and political time.

Democrats will put on a brave face. They will say it’s not over until it’s over, that the individual mandate was originally a Republican and Romney idea, that the justices will come to their senses, that this is a moral not a constitutional issue.

Republicans will say that the health law is a train wreck, that it was rooted in ego and arrogance of an overly ambitious president, that Democrats poisoned the whole politics process by completely ignoring the other party and the American public, and that the whole idea of individual and Medicaid mandates is toast.

If they are smart, and there is no guarantee of that, the GOP will issue a detailed alternative plan resting on incremental market reforms with proper government oversight.

“Inaction “ on Massive Scale

Over the next seven months, we are likely to have “inaction,” if I may borrow a term from the hearings, on a massive scale.

· The states, particularly the 27 who brought the suit to the Supreme Court, will stall or stop implementation of health exchanges.

· The Obama administration will step back and concentrate on campaigning on other issues to divert attention from its failed health reform law.

· The Romney team will focus on economic growth to distract from Romney’s Massachusetts health care legacy.

· American businesses, large and small, may hire at a modestly increased pace but will hold back because of continued uncertainty.

· The Medical Industrial Complex- hospitals, physicians, health plans, drug companies, nursing homes, rehabilitation centers, drug companies, medical device makers, and health IT companies – will continue to prepare for the next millennium, with or without Obamacare.

Trends in Motion Stay in Motion

However, certain trends in motion will stay in motion.

Paramount among these are:

· Decline in private practice

· Migration of physicians into concierge and other direct pay practices outside the province of 3^rd parties

· Consolidation of hospitals, physicians, and insurers into bigger entities to fend off and for leverage to negotiate with government

· Renewed emphasis by employers on health savings accounts, high deductibles, and other cost-lowering strategies.

· Decentralization of the system into smaller units outside the hospital and other non-institutional settings.

· Increased use of telemedicine and technologies to monitor and reach patients in virtual non-face-to face ways.

· Altered behavior patterns by physicians and patients alike, prompted and accelerated by social media and health IT corporations, as the nation seeks more sensible and affordable approaches to health care.

Richard L. Reece is a retired pathologist and the author of The Health Reform Maze: A Blueprint for Physician Practices. He blogs about health reform, medical innovation, and physician practices at medinnovationblog.