Saturday, April 23, 2016

After ObamaCare, Health Care Anywhere
It is today possible, to a greater extent than at any time in the world’s history, for a company to locate anywhere, to use resources from anywhere, to produce a product that can be sold anywhere.
Milton Friedman, as quoted in The Sovereign Individual
The test of a first-rate intelligence is the ability to hold two opposed ideas in the mind at the same time and still retain the ability to function.
Scott Fitzgerald, The Crackup
This week the heath care news foreboded  an approaching ObamaCare crackup – skyrocketing premiums in 2017, exchange  enrollments tumbling as people fled  from  exchanges after signing up and getting care, and a big insurer departing from exchanges because of unsustainable losses.
What manner of health system might follow the crack-up?
Two Part System
I believe it will be a dual system.
·         One part  will be government and integrated health care corporations featuring a vast interoperable  computer system, capable of making sense out of complexity, integrating information from multiple players and sources,  bringing together data to diagnose, treat, and manage  a diversity of conditions under federal and corporate umbrellas. That will be ObamaCare’s legacy. 

·         The other part, of equal size and perhaps of even greater magnitude ,  will be  a system consisting  of diverse organizations at diverse sites, delivering diverse  care anywhere and everywhere, in patients’  homes, at rehab facilities, in doctors’ offices, in urgent care centers,  and often at a distance,  virtually, personally, telemedically,   in cyberspace, outside the realm of government and third parties.
Because of the information revolution, we will see the rapid emergence of this dual system.   The federal and large organization part will be slow because of political controversies.  But it will be big in the news because government and political involvement.    T
he private, market-driven segment – more personal, market and customer-based, decentralized, and diverse will be rapid but  less in the news because it operates under the journalistic  radar.      It will be more high tech and high touch and more in touch with the will of the people, their personal  feelings, and their desire for more choices.
The changes will go as Steve Lahr foresaw in the New York Times (High Tech Alternati9ves to High-Cost Care,” NYT, May 22, 2010).
“Mention health care reform and the image that springs to mind is a big government program. But there is another broad transformation in health care underway, a powerful force for decentralized innovation. It is fueled in good part by technology – low-cost computing devices, digital sensors, and the Web.”
“The trend promises to shift a lot of diagnosis, monitoring, and treatment of disease from hospital and specialized clinics where treatment is expensive, to primary care physicians and patients themselves – at far less cost.”
And as I forecast in my book, The Health Reform Maze (Greenbranch Publishing, 2011):
“There is something curious and paradoxical going on out there. It combines high tech, low tech, high touch care innovations. It is a back-to-the-home movement - a yearning to escape from hospitals, specialized clinics, specialists, and those health plans we’ve come to dislike. It seeks high-tech alternatives to high-cost care. It wants high tech tests done at home by patients at home and monitored by doctors. “
Changes Well Underway

These changes are now well underway.   They are largely customer and market-based.  They are made possible by sophisticated computer systems and ubiquitous online use anywhere.  They are a response by health care consumers and physicians seeking refuge from unaffordable expenses, inexplicable regulations, and  inexcusable failure of government to deliver on its promises of lower cost more accessible t care.