By IAN MORRISON
I should’ve been in Paris last week on vacation with my wife, instead I listened in to the Policies Techies VCS: What’s Next For Healthcare conference (I’ll explain why later). Matthew Holt and Jessica DaMassa did a magnificent job of assembling the Who’s Who of digital health tech to wax lyrical about what the new kids on the block were up to, where it is all headed, and what it will mean for the system. (Full disclosure Matthew and Jess are friends of mine, I hired Matthew from Stanford almost 30 years ago to join the Institute For The Future (IFTF) and have watched proudly as he has become a Health 2.0 impresario. Jess simply deserves a gold medal for wrangling Holt and all the other tech Bros with wit, charm and intelligence).
This is a tumultuous time for digital health technology because of the pandemic and the related rise of digital solutions not to mention the very frothy investment market and massive deal flow over the last 24 months. There are a lot of exciting new faces. But, many of the companies on display have been at this for some. And for many of the old guard, like Livongo and now Transcarent Founder Glen Tullman, Athena Health and now Zus Founder Jonathan Bush, and Amwell CEO Roy Schoenberg and others this has been a much longer journey.
(Parenthetically, as a young management engineer in Canada, a position, I was not qualified for, I wrote the justification for an all-computerized hospital at the University of British Columbia in 1979! I still find it just incredibly pathetic that it has taken us 40 years to suddenly “discover” digital health. I wrote The Second Curve which forecast (among other things) the rise of digitally enabled health transformation 25 years ago! So it is hard for me to get really excited that this is either “new” or “next”.)
So, while a lot of us have been in this movie for a long time, there is something very different about the current crop of offerings. In particular, technology has advanced considerably and there are clearly new cloud and SaaS tech enabled care solutions. There is a new cadre of talented and committed investors and entrepreneurs who believe they have the capability and capital to scale meaningful enterprises that will disrupt incumbent healthcare players and better serve consumers and providers. And the timing seems right as the pandemic forced consumers and the health care system to confront new ways of doing business.
It was the Mother of unintended consequences.
By the time of the 2016 elections, health plans, hospitals and health systems had squeezed and consolidated and trimmed and cut costs under the gun of lower Medicare reimbursements and the new rules of Obamacare — but mostly they had adapted. Most of them had survived.
On November 9, the country woke to find itself with a Republican President-elect, a Republican majority in the House, and a Republican majority of 55 in the Senate. The Grand Old Party was dedicated to repealing #EveryWord of the Affordable Care Act, the hated Obamacare which was, after all, “destroying the country,” “the worst thing to happen to the country since the Civil War,” and “equivalent to slavery.”
The changes to healthcare did not wait until Inauguration Day, much less until the 115th Congress could assemble to gut the law. They began instantly.
November 9, of course, was just nine days into the annual Open Enrollment period for plans under the Affordable Care Act exchanges. Many of the 12.7 million who had signed up for 2016 could see that the subsidies they were getting through the exchanges would likely disappear in the wake of the election, and decided not to sign up. “Why chance it?” as Betty Cornwall of New Rhodes, Kentucky, put it to Fox News’ Megyn Kelly.
Health plan strategists, masters of not getting blindsided by risk, decided that it was a bad idea to sign up millions of people for plans without knowing what would happen to the law. They did not want to get stuck with serving people who did not pay, and did not want to get blamed for dumping people after they had signed up. So most large health plans withdrew immediately from the exchanges, before many more people could sign up, draining the exchanges in many states of any choices at all.
When you hear the word “empowerment,” it’s code for “You’re on your own, pal.”
Health care leaders are starting to recognize that consumers are becoming a major decision-making force. Let’s be clear at the outset: The rise of the consumer is not the panacea that will solve all our problems. It is a reality that hospitals and health systems must respond to. For the foreseeable future, consumers will pay more for health care and be more involved in picking plans, providers and individual treatment options. This development means significant financial consequences for consumers (unlike almost any other developed country).
Providers need to understand the financial predicament of the typical American health consumer and the responses consumers are making in this changing environment. At the same time, with a new congress and a political season of primaries and posturing just around the corner, pundits, politicians and plutocrats need to recognize where consumers are as voters, plan members, employees, patients and family members.
“I want your Ugly. I want your Disease
I want your Everything, as long as it’s Free.”
—America’s leading contemporary philosopher, Stefani Germanotta (aka Lady Gaga)
Insight comes from unlikely sources. Lady Gaga nailed the health reform dilemma. We have a healthcare delivery system that is an orgy of profligacy and excess that offers the false promise of making ugliness, disease and death all optional. And, we the public love all of it, as long as it’s free, at least to us as individuals. We want high tech, high quality, high expectations met, highly trained professionals delivering high standards, paid by someone else. And the magic fairy that will pay for all of this? Health insurance. Give everyone an insurance card and they can have their everything and it will be free, or close to it.
But wait, isn’t the cost of insurance tied to the costs of care? Doesn’t the sum of all healthcare costs for a covered population (plus administrative costs) divided by the number of people equal the premium. Doesn’t the premium come out of my pocket as taxpayer, employee or individual? How can I have everything, as long as it’s free?
Short answer is: you can’t.
We are caught in a Bad Romance with healthcare.