Monday, January 5, 2009

Ins and outs of health care in 2009

Around the first of the year normally rational people get into the prediction business. This happens even though experience tells us that no one, including the best experts, is particularly good at seeing the future. Think about it. One year ago, how many economists predicted that the year would end with a global economic meltdown? How many political pundits predicted Barack Obama would be elected president?

Still, in keeping with the spirit of a new year and with a full expectation of being proven wrong, this is my list of the health care trends that will be out and in style for 2009.

Out vs. In

Health care deregulation VS. Insurance market regulation
Health Savings Accounts VS. First dollar coverage of prevention
Buy coverage through individual markets VS. Buy coverage from a group health exchanges
Consumer-directed care VS. Patient-Centered Care
Medicare Advantage plans VS. Traditional Medicare
Pay for treatment of chronic diseases VS. Pay for prevention and management of chronic diseases
Pay-for-performance VS. Accountable care organizations
Fee-for-service VS. Bundled payments
States take the lead to expand Coverage VS. States cut back and look to Washington
Doctors accept gifts from pharma VS. Small gifts banned; mandatory disclosure of financial ties
Limited federal monies for HIT VS. HIT to get tens of $ billions
Fund special projects through earmarks VS. Fund special projects out of stimulus
46 million uninsured VS. Coverage for everyone
Disease management companies VS. Patient-centered medical homes
No federal regulation of tobacco VS. FDA to regulate tobacco
Flexible spending accounts VS. Tax credits to buy coverage
Medical necessity determinations VS. Comparative effectiveness research
Radiology, orthopedics, anesthesiology, and dermatology - the ROAD specialties VS. General internists, surgeons, and FPs

The list reflects the drawing to an end of the domination of health care policy-making by those with a fealty to market-based approaches. The new crew in Washington instead pledges to use the enormous power of the federal government to regulate health care insurance and benefits; to subsidize and guarantee coverage; to reform physician payments; to expand public programs like traditional Medicare; to rein in drug prices; to influence physician specialty choice; to fund health information technology; and to do so many other things.

Of course, whether the public will prefer the more regulated and subsidized health care system that could result will be a matter of a great debate.

Today's questions: Do you agree or disagree with my list of trends that will be in and out of style in 2009? What trends would be on your in and out list?


PCP said...

This is what it looks like. This is likely the direction the pendulum rationally needs to swing for balance in the system. This is however BEFORE the special interests have had their say. I'm more hopeful than I've been in some time that the Generalists might see something positive come out of this impetus for change. The political winds are certainly in the direction of the changes you've mentioned. That said there remains formidable opposition, and it will not happen without a major foodfight.
More interesting to me would be the maturity or lack thereof within the physician community. Unless specialty medicine realises the importance of this issue, which has come to an unsustainable state for Generalists, such that our very existence is threatened, it will get very nasty. One would hope that specialty medicine understands that it is time for our medical students to choose Generalist careers in greater proportions and accept the needed changes. Otherwise we seriously risk the fracture of organized medicine. The status quo has never been less acceptable for Generalists. We can all agree on most other changes needed in the health care system, however we ought not to make the inevitable rebalancing of resources divide us.

Steve Lucas said...

Good list.

PCP states: "The status quo has never been less acceptable for Generalists."

There is growing patient dissatisfaction with the current system in everything from cost to personal treatment by physicians and the medical community. Driving some of these changes will be a desire to move away from the "status quo."

Steve Lucas

Jay Larson MD said...

It is obvious that the current perverse health care system is not sustainable, nor should it be. At some point the health care system ran off the tracks. Personally, I would like several of the "Outs" to disappear and never return...46 million uninsured, disease management companies, and Medical necessity determinations.

Hopefully the "In's" will be pursued to get the system back on track. We need a system that is "patient-centered" with respect towards patients.

I would like the "patient is a widget" mentality out and the "patient is a person" mentality in.