I do not sense the end of dominant hospital systems. In Connecticut, where I live, two huge hospital systems, Yale New Haven and Hartford, each with revenues over $1 billion, have the lion's share of medical markets, both inpatient and outpatient through their central hospitals, acquired hospitals, and peripheral facilities, which feed the mother ships.
Elsewhere, however, I sense the beginning of an era of dispersed and customer-oriented markets, smaller and more flexible economic entities, a bolder and more decisive foreign policy, a mix of liberalism and conservative views, more migration of businesses across national borders, the economic rise of the IT-skilled and the a fall of those not skilled workers, and an increase in hacking and terrorist related crimes and a decrease in physical violence and large scale wars.
A Dual System
One will be dominated and controlled by government –Medicare, Medicaid, ObamaCare, and large integrated hospital organizations. These systems are generally reimbursed through 3rd parties, and for the general run of patients, have a significant flaw, high deductibles, which, for many patients, rules them out as a source of care.
The other part of the system will be characterized by cash-only and direct care delivered by individuals, small groups, and entrepreneurs offering convenient, personal, and direct care at multiple sites where efficiency is more important than power or size of the organization.
In many cases, these smaller outlets will be more economical for health care customers because of skyrocketing health premiums and deductibles, which render routine car unaffordable.
ObamaCare will survive in the dual system because it has taxpayer dollars to prop it up. But because of surging premiums and deductibles and UnitedHealth backing out of 34 markets, it is in trouble and financially unsustainable. Its fate depends on public approval which has dropped to 44% and to politics. Republicans have vowed to repeal either its mandates or the law as a whole.
Transitions to More Market-Based Entities