Wednesday, May 25, 2016

The Status Is Longer Quo: What It’s All About and Where It’s All Headed?
A physician friend asked what to expect in the near future.
I said, ”The status is no longer quo.”
”What does that mean,” he replied , where are we headed, and where does that leave me?”
It means  the information age has turned the world of politics and the world of health care upside down  and downside up.
Uprooted Political Establishment
It means the traditional political establishment , which has shaped health care policy in the past,  is being uprooted.   No matter who gets elected, it is likely that the individual and employer mandates will soon be gone and that electronic health records and physician payment policies  will  be altered.  
It is now apparent that ObamaCare doesn’t lower costs,  limits choice, and makes premiums, deductibles, and co-pays unaffordable for most of  the  unsubsidized middle class.   The middle class is mad as hell and may turn out in droves to do something about their economic plight and about perceived political corruption at high levels of government.
It means things are in flux.  It means things will never be the same again. 
On the Social Scene 
On the social scene,  it means minorities and elites are threatening  to become the majority.  It means blacks, thanks to a black president, will continue to  vote as a solid block.   It means white male workers  will also vote en mass the other wwyal  It means concern for the future exceeds nostalgia for the past.
 It means a resurgence in national pride,  middle class angst, and the silent majority.   It means more social unrest, with increases in crime  and declines in morality.   It means anger among workers  who have been displaced by the global economy and the information technology revolution.  It means a realignment of our culture, with more emphasis on identity politics, whether you’re black, white, Hispanic, Oriental, Islamic,  mixed, homosexual,  female, white male, or veteran.
On the Medical Scene
On the medical  scene,  it means a clash between data algorithms and human rhythms and desires.   It means  the emergence of possible ObamaCare alternatives,  such as market-based competitive care backed by Republicans.   And, at the same time, it means   a call for possible universal care as advocated by  Bernie Sanders and the millenials.   It means young physicians, in search of economic security and a balanced life style,  will go for hospital employment  or  higher paid specialties .  
It means widespread primary care shortages, and public unrest as growing numbers of physicians , facing federal budget cuts, unacceptable payment schemes, government interventions in patient relationships,  tell prospective patients,  “Sorry, we don’t take Medicare, Medicaid, or ObamaCare.    It means significant numbers of physicians will opt for  direct cash practices  outside the reach of 3rd parties to escape hassle factors.   
It means two simultaneous  movements are occurring ,  more hospital and big group consolidation,  and more care outside of hospitals in more private, personal , focused care, and concierge settings. 
 It means  more home care,   more IT monitoring of chronically ill patients in their homes,   and more home care visits. It means significant numbers of patients will delay physician visits,  seek alternative medical options,   treat themselves, or not take medications are prescribed.  Care will be delayed,  symptoms and illnesses will be neglected,  and care, when required, will be more expensive.
On the positive side,  it may mean people will concentrate more on prevention,  seek to stay fit,  monitor their fitness with electronic devices,  eat the proper foods, maintain a normal weigh, smoke less,   and avoid  excessive alcohol consumption and addictive drug an pot use. And at the federal level,  it may mean medical scientists at the National Institutes of Health, though genetic manipulation and immunotherapy,  will finally find effective ways to combat and cure multiple types of cancers.

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