Demystifying Medicine One Month at a Time

Tag: health care future

“The Future, Mr. Gittes. The Future!”*

The announcement of the proposed takeover of Aetna (a health insurer) by CVS (a drugstore chain calling itself a “pharmacy innovation company”) has become a big news story. What does it mean for U.S. health care? More importantly, how will it impact us as individual patients (what some like to call “customers”)?

I don’t know.

I’m not sure anyone has clarity on this yet. We’ll have to wait and see if the deal goes through, and then how the behemoth merged company brings efficiency or monopolistic pricing to the market.

Or both.

But if you want some other visions of the health care future, think about a hospital without patients as is detailed in this article from Politico.

Mercy Virtual, which opened in 2015, calls itself “the world’s first and only facility of its kind.” The 125,000 sq. foot building houses health professionals who remotely monitor and consult for dozens of hospitals and ICUs. It’s all done telephonically, er, remotely, errr, virtually.

[Another article in that same Politico issue makes the case against hospital beds, on the basis of bed rest being counterproductive for nearly every medical condition we treat. I used to get frustrated watching people ‘decondition’ while laying around in bed. It’s a serious problem, especially in the elderly.]

Which leads directly to another future question: is the age of the virtualist upon us? Yes, as predicted in a recent JAMA column by Dr. Michael Nochomovitz, who makes the case for a medical specialty devoted to care of patients through technology.

It may be the way of the future, but it sure makes performing physical exams harder.

These times. They are a changin’.

*Chinatown. Noah Cross (played by John Huston) to private investigator J.J. Gittes (Jack Nicholson). 

The Choice

In two days, we will elect a President who will serve for the next four years.

Despite all the money spent, the rhetoric (or lack thereof), and the continual assault of election-based coverage aimed at all (or microtargetted slices) of us, there are certainties about our future regardless of who is elected:

  • Health care will continue to be an important and divisive issue.
  • Overall health care costs will continue to rise.
  • The health care industry will continue undergoing radical change; so much so, that I predict by the 2020s your basic conception of ‘health care’ and how you interact with the system will be vastly different than it is now.

Don’t get me wrong. The election matters a great deal. In regard to health care, who is elected will impact how these inevitable changes occur and the pace at which they happen.

Of course, in the offing is full enactment of President Obama’s Affordable Care Act (aka ‘Obamacare’) on January 1, 2014. Candidate Romney has promised to block, de-enact, and ulitmately repeal the legislation. The framing of the debate on health care is often over-simplified to fall better into the ‘size of government’ debate–such that if you think government is too big, and that’s a decisive factor for you, the vote as a referendum on Obamacare makes sense. If you believe that the tenets of Obamacare–providing health insurance to nearly all Americans and reforming the way that we finance health care–then your vote likely fits nicely into the narrative of people needing a minimal level of support to avoid catastrophe, bankruptcy, and have some level of opportunity for achievement in this land of ours.

Here is GlassHospital’s list of predictions on where US health care is headed regardless of Tuesday’s choice:

  1. Health care will continue to undergo massive consolidation. Large players (hospitals, health systems, and insurance companies) will get increasingly larger. Doctors will continue losing autonomy as independent agents and will increasingly become employees of these large corporations.
  2. Technology will continue to drive change: On the high-priced end, newer diagnostic and therapeutic technologies will continue to provide cost pressure to the system which will rub raw Americans’ belief that we can be entitled to treatments no matter the cost when we’re the one affected with the disease. We will have to set limits (yes, limits!) on expensive treatments for which there is little to no evidence of benefit to patients (other than claims of ‘latest and greatest.’)
  3. The health care work force, and how you access it will change dramatically. Who you see will be different–it’ll be much less likely to be a doctor. It will be a nurse or a physician’s assistant, or in some cases, a community health worker with specialized training.

In addition, regarding #3 above:

  • You will be more likely to see these newer types of health care professionals in cyberspace, at your workplace, at the pharmacy, or at other points of contact in the economy (Walmart, etc.).
  • You will continue to pay more out of your own pocket, but you will get incentivized for ‘good behavior’ i.e. vaccinations and age-appropriate screenings, as well as better nutrition, weight and avoidance of tobacco.
  • We will move to more a la carte system of health care–where if you want it, you can pay for it. At one extreme, DIY medicine will be the biggest theme of the 2010s and 20s–just as with other hobbies and technologies, medicine will continue to be absorbed by the people and for the people. Fed up with a changing and chaotic system, more DIYers will take matters into their own hands. At the high end of the income and price scale, this means there will be no limits on care for those with the means to afford it.
  • Ethically, there will be calls for physicians to abstain from serving as mere functionaries and technicians, and to continue to exercise professional judgement and not feed the maw of unnecessary and expensive over-treatment, but this horse has already left the barn.

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