Approaches To Alternative Care Delivery

Ideas and thoughts on how care delivery can be transformed… 

Now, About Health Care Reform – While the news seems to be all about the pandemic, there are underlying consequences that those of us in health care should be seriously considering.  One of THE major issues in the next six months leading up to the November Presidential elections is “health insurance”. A recent article in Lancet caught my attention on the savings that could potentially accrue from a Medicare-for-All Act.  What is especially important to be considering is that over the last year public debt has grown by – at last count – by over $2 trillion. To be specific, U.S. public debt was about 23.7 trillion or, more than 1.65 trillion more than a year earlier. But, that was BEFORE all of the legislation passed by Congress to deal with the pandemic.  Now, I’m not arguing against the moves by Congress to help businesses and those in need.  That’s what government is for…that’s why we are the “United” States of America. However, the growth of public debt on top of an exploding debt load creates a morass and – health care will be target #1 for managing the debt. Those of us in the health care field know that the cost of health care in the US compared to other nations is exceedingly high. There are compounding factors, however, that make this issue even more important as the pandemic recedes (or, doesn’t – argh). First, we have a decline in the number of primary care providers due to age and loss of interest among younger physicians. Second, the boomers are coming of an age where the use of health care services will skyrocket. I’ve been arguing for some time that the age wave tsunami will be the major force that will precipitate health care reform. Third, an unanticipated (by some) pandemic occurred that is creating crushing additions to our national debt. But, there are solutions – which gets into my long diatribe on what we need to be doing to solve the problem. For the moment, let’s stay with the national debt problem which not only is causing political turmoil between Democrats and Republicans but is now spilling over into a public demanding access to care.

Last year, the Congressional Budget Office (CBO) released its Long-Term Budget Outlook report which repeated prior warnings on the federal budget’s unsustainable long-term trajectory. The CBO’s report articulated the following (a cut and paste from their “publicly available” report):

  • Debt is Rising Unsustainably.Under current law, CBO projects federal debt held by the public will rise from 78% of GDP this year to 144% by 2049 – more than a third higher than the historic record of 106% set just after World War II.
  • Spending is Growing Faster than Revenue.CBO projects spending will grow rapidly, from less than 21% of GDP in 2019 to over 28% by 2049. Revenue will grow more slowly, from 16.5% of GDP this year to 19.5% by 2049. As a result, annual deficits are expected to more than double from 4.2% of GDP in 2019 to 8.7% by 2049. But, note – these findings were pre-COVID-19!!
  • Major Trust Funds Are Headed Toward Insolvency.CBO projects the Highway, Pension Benefit Guaranty Corporation Multi-Employer, Medicare Hospital Insurance, Social Security Disability Insurance, and Social Security Old-Age and Survivors Insurance trust funds will all be exhausted in the next 13 years without action to stabilize their finances. Now, if we want to create a Boomer revolt in this country – we will ignore these specific CBO findings!!
  • High and Rising Debt Will Have Adverse and Potentially Dangerous Consequences.CBO estimates that income per person would be almost $9,000 higher in 2049 if we fix the debt compared to continuing current policy as in CBO’s alternative scenario. …Rising debt will slow income growth, increase interest payments, place upward pressure on interest rates, weaken the ability to respond to the next recession or emergency, place an undue burden on future generations, and heighten the risk of a fiscal crisis. So, if as an alternative to the Boomer revolution, we want to create a Millennial revolt – we will ignore these specific CBO findings!!
  • Fixing the Debt Will Get Harder the Longer Policymakers Wait. Delaying necessary deficit reduction means larger spending cuts and tax increases concentrated on fewer people. CBO estimates the size of the adjustment would grow by 50% if policymakers wait ten years to take action. In other words – if the current leaders don’t solve the problem soon, the future leaders will be left with a huge problem. Perhaps we should get the future leaders on board sooner…

Long story short, my prediction is that Medicare, Medicaid and Social Security will be front of mind in the coming election cycle and, regardless of outcome, will be target #1 in the next Congressional debate.

Now, back to the Lancet article.  In essence, the article argues that the ongoing efforts to “repeal and replace” the Affordable Care Act (or, undermine it in various fashions) is exacerbating health-care inequities. The authors argue that “a universal system, such as that proposed in the Medicare for All Act, has the potential to transform the availability and efficiency of American health-care services.” Specifically, they calculate that a single-payer, universal health-care system would most likely lead to a 13% savings in national health-care expenditure or, about $450 billion on an annual basis. With the debt piling up the way it is as a result of the pandemic, every penny, dime or nickel will be scrutinized in the coming decades.  Again, health care will be front and center.  Mark my word. 

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