Thirty years from now, in the year 2045, a concierge will know your healthcare team, your medical condition and your values. Lower-skilled people aided with technology will get diagnoses right more often than doctors. Healthcare will be more universal because mid-level professionals are cheaper and better although there is no universal healthcare. In fact, in Michael Cannon’s world, there is no Medicaid, Medicare or even the FDA. Insurers compete to get your business in a marketplace without mandates and subsidies, according to the director of health policy studies at the Cato Institute.
Conversely, Sean Kolmer, health policy advisor to Gov. Kate Brown, sees a future that “might look like what we’re doing” now with coordinated care organizations. Both political parties supported the creation of CCOs which have allowed local communities to prioritize the delivery of healthcare.
“We expect them to live within their budgets and then get out of their way,” Kolmer said. Currently, one million Oregonians receive care through a CCO, with the state purchasing insurance for 1.3 million people -- nearly one in three statewide.
Between 1996 and 2010, he said, insurance premiums rose by 300 percent with a wide variety in costs for similar outcomes. “This won’t change unless purchasers – those paying the bills – demand something better.”
But Cannon believes “the system serves people who control the money. The political process responds to those with resources such as incumbent providers, hospitals and delivery systems. Lower costs and higher quality care disrupts” the existing system.
He prefers to let consumers decide for themselves how much insurance they want. “Tools will emerge to help people make these decisions. People can sort themselves into the healthcare delivery model they want. You need the consumer to care about the price…They don’t make as careful decisions when they’re spending other people’s money.”
Cannon believes prices are not a secret. “So much of our healthcare spending is done by third parties, and you won’t see competition until people pay 100 percent of their healthcare. Price transparency is not a problem for people who control the money.”
Kolmer sees more of a need to “put money where our mouth is.” Medicaid can pay to reduce hospital readmissions. “Whatever you believe you want, be willing to pay for it. We’re paying hospitals to keep people out of hospitals.”
“How long did it take to realize fee-for-service creates a perverse incentive in favor or readmissions – 50 years?” Cannon asked.
Kolmer also believes CCOs need to spend more resources on social, environmental, biological and behavioral determinants of health instead of focusing exclusively on what happens in a medical setting.
Is there a government role for providing for the poor in Cannon’s vision of the future?
“I’m not going to claim there won’t be unmet need,” Cannon said. “Sometimes people buy too little insurance or too much. They will bear the cost of their mistakes. Even in Libertopia, there’s going to be people who make bad decisions. How much do we do for people?”
The CCO model provides opportunities for innovation and sharing best practices -- with flexibility, Kolmer said. “Communities bring solutions we didn’t think of. We’re asking them to focus on the outcome. ‘Here’s how you can do it but you don’t have to do it that way.’ “There isn’t a finish line to any of this.” Jan can be reached at [email protected].
