What Do Millennials Want from the Healthcare System?

What Do Millennials Want from the Healthcare System?


The 18-34 year old segment of our population is large, growing and important in our society. They are 80 million strong. Their attitudes, beliefs, values and actions are re-shaping the way every organization, business and institution thinks about its future.

According to a Pew Research report released last week, Millennials are independents and skeptics: 50% have no political affiliation, 29% no religious affiliation, and 19% say they do not trust established institutions to do the right things (versus 40% for Baby Boomers).

Millennials worry about money. A study by the Investor Education Foundation of the Financial Industry Regulatory Authority concluded that their concerns about their auto, credit card and school debt trump other issues.

Most think economic stability should come before marriage and family life. Half who went to college have a student loan to repay, and one third moved into the homes of their parents at some point to make ends meet.

And they worry about the future. Paul Taylor’s The Next America: Boomers, Millennials, and the Looming Generational Showdown predicts economic battle between Millennials and Baby Boomers:

“Every family, on some level, is a barter between the generations…If I care for you when you’re young so you’ll care for me when I’m old…But many Millennials won’t be able to afford that…The young today are paying taxes to support a level of benefits for the old that they themselves have no prospect of receiving when they become old.”

Pew survey data supports his contention:

  • 51% of Millennials do not think there will be any money for them in the Social Security system by the time they retire.
  • 39% believe they’ll get reduced benefits

So what do Millennials want from the health system? Their view is likely to disrupt how industry leaders operate their businesses and how policymakers make laws that govern its commerce.

Like the economy and financial matters, their knowledge about the health system is somewhat lacking in specifics, but their opinions are rooted in three strongly held beliefs espoused by the majority in their ranks who regard them as imperatives:

Make it about health. Millennials think the U.S. healthcare system is fundamentally flawed. They believe it is purposely geared toward the sickest and oldest, and structured to profit from their treatment. They want a system of health that balances resources for the young and healthy with compassionate care for the elderly and sick.

They want a system that pays for a blend of mind-body therapies, embraces healthy food, clean air and spirituality as central elements alongside medicines, and allows individuals to make choices at the beginning and end of their lives. They want a system wherein preventive health and primary care is holistic, widely accessible, and respected as a reflection of a community’s core values.

And they believe incentives should reward healthiness in lieu of volume for procedures, testing and drugs. They see a sick care system; they want a health system.

Make it simple. Millennials approach life through the lens of the micro-communities where they live, work and recreate. They are dependent on iPhones, NetFlix, iTunes and social media, and are pre-disposed against big government, big business, big religion, big politics and big healthcare.

They want a local health care system that’s simple: paperless, treatments that are necessary and easily understood, prices that are sensible and transparent, and caregivers who listen and connect.

Most prefer to pay a reasonable single payment monthly to cover everything–no co-pays, deductibles, premiums and out of pocket for what’s not covered. And many think a single payer, government run system might be more easy to navigate than the hodge-podge of programs and plans they see at work and in their community.

Make it accessible. Millennials think healthcare is a right, not a privilege for those of means. They believe basic healthcare should be the same for all; they believe profits should be subordinate to its purpose. They want ownership of their medical record, information about the clinical outcomes and financial incentives of their caregivers, and ubiquitous access to health information through their mobile devices.

They want services that are coordinated and a solution to the menacing gaps in care for those lacking insurance. And they want an end to the intramural jousting over the future of the health system between primary care and specialty clinicians, hospitals and private insurers, Republicans and Democrats, and other warring factions.

Last week, with a group of health executives, I visited the campus of Zappos in Las Vegas where 1500 Millennials live and work operating a successful online apparel marketplace recently acquired by Amazon. Its business is a means to an end; its purpose is to create a culture of connectivity and service that rewards individual and collective efforts that make their community happier, healthier, and productive.

Its Downtown Project is not about economic development; it’s about people living together to meet common needs including healthcare.

Millennials are not a homogenous population, but their voices about healthcare seem consistent and in unison. The Zappos faithful are not too different from the ranks of their youthful peers in every community in America. They are watching the journeys of their parents and grandparents through endless paperwork, inexplicable costs, non-responsive providers and insurance that seems geared more to profit than coverage.

They know the system of care in the U.S. is better for those with private insurance than for those without, and they know health reform is political quicksand for well-intended policymakers seeking to correct its fundamental flaws.

Health matters to Millennials. They want a health system that’s different than the status quo. Those who choose to dismiss their views as naïve or ill-informed should reconsider. This generation is reshaping the landscape in our society one industry at a time. It’s likely healthcare will be among them. And their imperatives about its future will be heard.

Paul Keckley, PhD is an independent health care industry analyst, policy expert and entrepreneur. Keckley most recently served as Executive Director of the Deloitte Center for Health Solutions and currently serves on the boards of the Ohio State University Medical Center, Healthcare Financial Management Leadership Council, and Lipscomb University College of Pharmacy. He is member of the Health Executive Network and advisor to the Bipartisan Policy Center in Washington DC.  Keckley writes a weekly health reform newsletter, The Keckley Report, where this post originally appeared.

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54 Comments on "What Do Millennials Want from the Healthcare System?"

Mar 24, 2015

“Every family, on some level, is a barter between the generations…If I care for you when you’re young so you’ll care for me when I’m old…”
Great Words. True Meaning of life


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Mar 25, 2014

I just want to be able to get treatments and pay a monthly fee based on my salary. Shall surgeries be needed, getting a discount would be nice too.

Joel Hassman, MD
Mar 23, 2014

i don’t write the stupid lol crap, I just write it as it is:


Gotta love how the partisan hacks in the media, even when reporting something that really is bad, still try to spin it as a basic “no big deal” with words like “glitch”. Umm, is being told you are due money that you don’t get, or worse, told you don’t owe anything and then are handed a bill a “glitch” to most on the receiving end of such idiocy?

the link: http://articles.philly.com/2014-03-22/news/48443001_1_tax-credit-insurance-premium-healthcare-gov

the “problem”: “Nearly six months after the disastrous launch of Healthcare.gov, with the website running smoothly and more than five million people signed up as open enrollment heads to a close, a new glitch has come to light: Incorrect poverty-level guidelines are automatically telling what could be tens of thousands of eligible people they do not qualify for subsidized insurance.”

Gee, which could affect which group of potential enrollees the most? Perhaps, the Millennials who are literally banking on this to allow them to get the coverage.

How about this one in the article as well: “It also highlights what some public policy experts say is a troubling lack of transparency in the marketplace’s eligibility determinations.”

Wow, what a surprise, a revelation, a discovery! The Obama administration and his minions trying to force this sewage down our throats is still screwing up this legislative application. And hiding it as voraciously as possible!

Oh, and I read last night the White House is now considering delaying the mandate end date of March 31 to what, November 5 2014? Just to insure those 7 million finally enroll?

Face it, if any republican did this, the media howls would make 50mph winds sound quiet. So many commenters here redefine “disingenuous and dishonest”, it is nothing less than hideous and disgusting how partisan interests trump public welfare every frickin’ time.

I’ll finish with this from a usual post and comment author here in the article: “I have to say, I probably would have made the same mistake if I were in charge,” said [Robert Laszewski, a former insurance-industry executive who is president of Health Policy and Strategy Associates] Laszewski, the former industry executive. “But they’re not supposed to make that mistake.”

Mar 23, 2014

BTW where is Maggie Mahar?

Joel Hassman, MD
Mar 23, 2014

Who cares!

Barry Carol
Mar 22, 2014


There are slightly over 10 million seniors who are eligible for both Medicare and Medicaid. They are referred to as Medicare / Medicaid eligible (MME), dual eligible or duals, take your pick. Anyway, they account for $350 billion of health system spending per year. Interestingly, if you look at the most expensive 10% of this population that have their bills paid by Medicaid and the top 10% with bills paid by Medicare, there is almost no overlap at all. It turns out that the expensive Medicaid patients are those who need long term care in a skilled nursing facility or lots of home healthcare. The expensive Medicare patients are frequent flyers in hospital emergency rooms with many suffering from congestive heart failure (CHF) and / or mental illness.

In any given year, the healthiest 50% of seniors (26 million people) account for only 4% of Medicare costs though they are not exactly the same people from year to year. Healthcare has always been referred to as a 5-50 business meaning that in any given year, the most expensive 5% of the population accounts for 50% of costs. The most expensive 10% account for about 65% of costs and the most expensive 1% drive 20% of costs.

My impression is that there is lots of futile care at or near the end of life except that doctors can’t predict exactly when the end of life will occur though, in the case of cancer, they often can at the very end. On the positive side, more people are choosing hospice and/or palliative care at the end of life in recent years. Often it’s the adult children that can’t let go but the patient can no longer communicate. That’s why we need more people to execute living wills and advance directives or at least prepare an informal memo for the kids that describe their wishes if it’s too uncomfortable to have an actual conversation with them.

Mar 22, 2014

Make sure to look at the data from palliative care studies. Those who opt not to use aggressive care end up living (on average) longer than those who don’t. And have lower costs and higher quality of life. So those relatives who “can’t let go” may actually be hastening their loved ones’ demise.

Bob Hertz
Mar 22, 2014

Thanks Barry.

Using your categories of basic vs catastrophic, my impression is that basic care is relatively cheap.

I recently read that the individuals on Medicaid who do NOT require transplants, dialysis ,AIDS drugs, etc have an average annual insurance cost of $564.
(Harold Pollack quote)

And that is without any deductibles or coinsurance, which are supposedly so important to cost control.

If our goal is get cheaper health insurance, then more preventive care will not do the job. Denying certain back surgeries will not do the job.

We have to confront what is spent on hail-mary treatments that actually work.


Barry Carol
Mar 22, 2014

Bob –

I think basic care is anything that isn’t catastrophic or rescue care. In the latter category, I would include trauma care, organ transplants, kidney dialysis, cancer treatment and sophisticated surgeries including cardiac and orthopedic procedures. In the former, I would include standard imaging and lab tests, stiches for relatively minor injuries and management of chronic disease including diabetes, asthma, hypertension, COPD, CHF, ischemic heart disease and depression. Preventive care is open to debate as even the tests that earn an A or B from the Preventive Services Task Force may do as much harm as good due to false positives which trigger additional testing and interventions.


The National Association of Insurance Commissioners (NAIC) was the group that did most of the work on developing the criteria that defined how the minimum medical loss ratios were to be calculated as both the components of the numerator and denominator that go into the calculation had to be precisely defined and determined. There was a lot of complexity there. There is no reason why the same group, working with the insurers, could not develop more uniform rules, procedures and forms related to defining and verifying coverage and filing claims to make life simpler and easier for providers. No anti-trust exemption would be needed.

Insurers could also do more to standardize and simply their insurance plans into a good, better, best approach along with a bare bones catastrophic offering. There is no reason why pricing, especially for hospital based care, can’t be reduced to a conversion factor that would be a simple multiple of the local Medicare rate and then publicly disclosed. For teaching hospitals and safety net hospitals, this rate would exclude the add-ons intended to cover the cost of medical education and providing care to a large number of uninsured patients. Those last two pools nationally come to about $19-$20 billion per year, I believe.

Bob Hertz
Mar 22, 2014

The ACA was designed to give every American the chance to buy a health insurance policy.

(or get a free policy from Medicaid)

We can see how well that is working.

Trying to guarantee access to basic health care creates two problems:

a. There is wide disagreement on what constitutes basic health care.
All would agree that a broken leg is basic health care.

But what about diabetes care for someone who has overeaten for 30 years?

b. Even to guarantee treatment for broken legs, some method must be found to pay the safety net hospitals for anyone they take in.

Personally I think this should be easy to solve. Just raise taxes by about $20 billion to cover EMTALA admissions for anyone who is poor and uninsured.

But for the last 28 years Congress has never gotten around to this easy solution.

Mar 22, 2014


I would have to guesstimate the effect of Medicare for all rather than the current system.

Generally commercial insurers pay more than Medicare, Medicaid pays much less than Medicare and we have a significant number of no pay/uncollectible in our hospitals – particularly in the ER.

My guesstimate is that going to all Medicare would be a wash.

I will say that billing Medicare is relatively straightforward compared to the pre-auths, denials, loop holes and other nonsense involved in billing some of the commercial insurers (Particularly United Healthcare).

As to whether a government single payor or an organized system of insurers is better – I really don’t care. But what we have is a disorganized mish-mash of different payors, all with different rules and different coverage.

I believe every American should have access to decent BASIC health care regardless of who they work for – or even if they are unemployed. The ACA was supposed to provide this but just seems to have made things more complicated rather than solving the problem.

Barry Carol
Mar 22, 2014

Bob and legacyflyer,

I’m not a big fan of covering lots of preventive care as part of health insurance for several reasons. First, it doesn’t save money for the system over the long term. Second, it results in plenty of false positives that trigger additional interventions which subject patients to risk and potential harm. Third, Leonard Schaeffer, in his 2007 Shattuck Lecture, told us that an individual’s health status is determined 40% by personal behavior (diet, exercise, smoking, drinking, etc.), 30% by genetic factors, 20% by socioeconomic status and environmental factors (sub-standard housing, dangerous neighborhoods and the like) and only 10% by the quality of healthcare one has access to. Finally, I see prevention as a matter of personal responsibility. I don’t need an insurer to encourage me to maintain my car and my home. I shouldn’t need one to help me maintain my body either though I wouldn’t have a problem with non-profit hospitals and community health clinics offering free blood and urine chemistry screenings once a year as part of their community service mission.

One issue that I disagree with legacyflyer on is the desirability of a single payer healthcare system. While advocates put way too much emphasis on keeping administrative costs down, there is likely to be too much fraud, at least in the U.S. and a lack of innovation on the delivery side. Liberal health economist Uwe Reinhardt says that single payer systems basically just pay bills. I would also prefer to keep politicians largely out of determining what’s covered and what’s not. There is a lot more that insurers can do to standardize administrative processes to make billing and documentation easier for providers and there is likely to be lots of consolidation in the health insurance industry over the next 5-10 years that should help reduce administrative complexity.

Only Canada and the UK have pure single payer systems in North America and Western Europe. Taiwan has one as well and France has what amounts to Medicare for all but it only covers 70% of the bills and the French people pay 13% of income on average in taxes to finance that. Most of the population also needs and buys a robust supplemental plan to cover the other 30% of charges. Germany, Switzerland and Netherlands use insurers. Sweden used to have a single payer system but went back to using insurers.

In Switzerland, insurers all have to cover the same mandated benefits package but are allowed to vary the deductible between 300 and 2,300 CHF per person (about $350 to $2,650 at current exchange rates). I would allow the deductible to vary between about $500 and $10,000 per person.

Finally, I would be curious about how legacyflyer’s radiology group’s revenue and net income would be affected if it were paid Medicare rates from all comers including Medicaid patients but there was no uncompensated care.

Mar 22, 2014


You raise a very good point. Health insurance in the minds of some people has expanded to include a lot more than just insurance. And perhaps the more expansive view is a better way to look at it …

But in a situation like that of some millennials, where being able to afford any insurance at all is in doubt, I would say that a limited policy is better than none.

Mar 22, 2014

You might enjoy the writings of Alison Hoffman on health insurance.
She says that in America there are two profoundly different views on what insurance is meant to do.

One view is that insurance should actually make us healthier. Thus the push for free preventive care, damn the cost in premiums…kind of an HMO for all.

The other view is that insurance should focus on financial catastrophes….which I think is more or less your position. If we do not use our own money for preventive care, tough.

I am not wise enough to know which is right. I do know that the two sides in this debate often seem to be talking past each other.

Mar 21, 2014

Bob Hertz,

You assume correctly, I am male.

Yes all those mandated forms of coverage could be of value to certain people at certain times. However, the inclusion of all of them raises the price of insurance making it less affordable. In my estimation, for a 27 y.o. millennial with limited income and educational debt, the ability to insure against an unlikely catastrophic accident is more important than having an insurance company pay for check ups, prescriptions, etc.

And by running routine costs like prescriptions, check ups, etc. through insurance, you add at least 20% overhead on top of the cost. (Why are people so anxious to sell extended warranties on cars – is it because it is a good deal for you or profitable to them?)

As I have said before, I am in favor of a single payor system. The ACA is an complicated Rube Goldberg way of paying for health care that, as far as I am concerned, is a re-arrangement of the deck chairs on the Titanic.