When it comes to American healthcare, we’ve become really good at highlighting its failings. Watching the flurry of lamentations, frustrations, denigrations, and prognostications, over the last few weeks, would lead any rational person to believe that nothing is working in our healthcare system. And, not only is it “not working,” many people conclude that it is actively harming people and society.
Broken “healthcare” has become a convenient scapegoat for almost everything ailing American culture: greed, indifference, incivility, evil, inefficiency, poor health, obesity, unhappiness, failing businesses, personal bankruptcy, government fiscal problems, decreasing lifespans, etc. Why not? There is more than enough room under the $5 trillion healthcare tent to throw all of life’s problems.
The problem with the big tent approach is that particularities tend to get lost the more zeros you add after a number. Especially if there are 12 zeros. Few of us can even begin to get our heads around what a trillion actually is – it is pretty much incomprehensible.
Big problems? Queue the big levers. At such scale, the only possible way to get things under control is to go to something bigger, right? Enter government. Curiously, U.S. Federal revenue is about equal to our healthcare economy. Hmmm, that starts to put things into perspective.
Of course, what does it mean to “get things under control”? Big levers from a government perspective means legislation, regulation, and bureaucracy. With the government, the big “fix” relies on legislating away the bad behaviors, putting controls on things like pricing, and creating more bureaucracy to monitor and enforce compliance. This approach further complicates a system that is complex beyond reckoning.
Health industry observer and consultant John G. Singer points out that “you can’t fix an embedded economic system.” Yet, the chorus of complaints and calls center on just that: fixing something that cannot be fixed. There are simply too many competing economic, and social, interests to repair what we call our “healthcare system.”
At this point, there is no stopping the train that is government regulation. The “what” of 2025 will center on big levers and the leviathans of healthcare will be fighting a political ground war to protect their interests. The result will be incremental change wrapped in tough words like transparency and accountability while total costs will remain high and the organizations targeted by regulatory animus, now publicly censured, reposition around “new” attitudes and policies demonstrating their good faith efforts to be better corporate citizens.
Forgive the cynicism, but this approach is not the answer that will produce a better system, better pricing, or better health.
The real question for 2025 is not “what will it be?” – the “what” will be a storm of public posturing, punishment, regulation, and populist politics. The real question for 2025 is “Who will it be?”
American healthcare doesn’t need big-lever “fixes,” it needs boots-on-the ground innovation and fundamental change. It doesn’t need more regulation to squelch the bad actors, it needs to remove barriers to those who have new ideas. It doesn’t need to focus control in a limited set of hands in one statehouse or another, it needs to unleash the creativity of those who are already way down the road of American Healthcare 2.0. Or is it 3.0?
To the real questions of 2025. WHO will…
- Propose innovative alternatives to the systems as we know them? Not the “SYSTEM” as a whole but the parts of it that can be deconstructed and rebuilt. Part of this is leaving cliched terms like “discount,” “rebate,” “payer,” “network,” and “system” behind. We need a new lexicon. Think less “network” and more “direct contract.” Less “discount” and more “cost plus.” Less “rebate” and more “transparent price.”
- Make the bold choices to take risks on business model ideas and new payment structures? This means redefining terms like “PBM,” “TPA,” “plan,” and “health” in the context of new measures of value and success with a radically different approach to executing on them. See #1 above.
- Do the incredibly hard work at the grass roots level of putting the pieces in place to remove access, cost, and complexity, barriers? We’ve got so many great ideas but they take work. A lot of work. Many are really good at talking about it, complaining about it, hypothesizing about it. Who will put in that hard work and sustain it over a long period of time to achieve aims?
- Take chances on lesser known solutions that approach it all differently? Change cannot happen if we keep calling-in the same players. We will not escape status quo until we leave the known and familiar.
- Implement multi-year strategies knowing that deeper change requires a long game approach? Objectives need to be defined over a long enough horizon to implement changes and allow their effects to bear fruit. This is truly a game of sowing, nurturing, and reaping in the right time.
- Dare to move off of the embedded system that holds their organization and their employees in a state of increasing costs and decreasing health? We’ve been sold a lot of solutions over the years. Can we believe that there are actually viable ways to change? Will we?
- Work to remove regulatory barriers to innovation, fight against wide net legislation that impedes the innovators, and strive for simplicity in bringing government power to bear? Politicians and regulators do have a critical role to play. Will they see themselves solely as policemen and judges or can they imagine themselves as enablers helping the upstarts actually bring change?
- See beyond short term profits and Imagine the “system” as being responsible for human flourishing through the continuous production of affordable health? Raw capitalism without a moral center damages trust in free markets. Do we have the courage to see business as a force for good and approach healthcare markets and consumers with a stewardship mentality? Can we see the economic and health wins in it?
- Dare to believe that there is a fundamentally better way to deliver, support, and pay for, healthcare in the United States and we can get there in a matter of years? Movement forward begins with the faith that it is possible.
There is a rising tide of change in American healthcare and it is not appearing in most headlines. Innovation is happening at the ground level, particularly in the efforts of self-funded payers. Innovators are doing the hard work on the foundation of healthcare with new approaches, systems, technologies, programs, and models.
Can we stay out of their way long enough or maybe even help them by supporting them in their efforts? There is a necessary place for private and public collaboration, with profound innovation possible through well-meaning boldness by both.
There is plenty of “what” being thrown around. Who is going to do something creative, different, and impactful? 2025 promises to be a very, very, exciting year.
