Health Care Thoughts: Reform Status According to Really Smart People
by Tom aka Rusty Rustbelt
Health Care Thoughts: Reform Status According to Really Smart People
So after two days in rooms full of top notch front line experts, and two nights sleeping on a couch in a hospital waiting room, I offer a list of key take-aways.. This is reporting only, not advocacy. Some of my opinions may vary (not much). I avoid the nitty-grittiest of operational details. So…..
The amount and complexity of work to be done in the next 24 months is crushing and impossible – expect delays or sloppy rollouts.
Scale is everything, small providers will get crushed. Impacts on rural health care uncertain, so…
Consolidation and integration is the critical path. Some bad outcomes likely.
The Obama administration is incapable of producing regulations and guidance papers on time (in Washington a little late is considered on time).
Providers are preparing cuts both permenant and “cliff” cuts.
The amount and complexity of IT work through the system is staggering. Data is the new currency of health care.
Setting up the exchanges is a massive and messy task, even in the enthusiastic states. Letting the feds install “plug-and-play” may become a good option for many states.
Some large public companies are seriously considering dropping health insurance and paying the penalty (stunned me). No decisions yet known.
Winners, sorta in sequence:
Health IT – vendor companies and geeks
Health lawyers – transaction and regulatory
Health executives – the “talent wars” are going full blast
Health CPAs, finance officers and consultants
Physician executives
Nursing executives
Bureaucrats and regulatory
Losers
Physicians – mostly (depends on many factors)
Nurses – hands on care givers
Therapist and ancillary providers
Hospital support staff
Getting a child ready for college? Push them towards…..
IT, health emphasis
Health care administration
Medical records administration / health informatics
Medical coding (good jobs with 2 year degree)
Accounting and finance, health emphasis
Actuarial science
Private health insurers may be really big winners (oops). Some private health insurers are building primary care networks and ACOs.
There are some intesresting and even exciting geriatric care innovations morphing out of the Obama administration, academia and providers.
The “old elderly” are using huge amounts of Medicare resources, innovations may cut usage with the same or better care.
Hospital capital spending is going wild as a market share play, just what we don’t need.
So, now to plug through a thousand or so pages on operational and regulatory details. Did I mention the Obama administration writes a lot of long and largely incomprehensible regulations and guidance statements?
Interesting times ahead.
Tom aka Rusty
LOSERS
Physicians – mostly (depends on many factors)
Nurses – hands on care givers
Therapist and ancillary providers
Hospital support staff
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Thank you Tom for your usual good work. Yes, that list is something that has seemed likely to me for quite some time. I don’t see how out of control healthcare costs can be trimmed without impacting the income of healthcare professionals. Further, I think that income is probably going to fall substantially even if reform fails. I have never seen how 18% of GDP (and increasing) for healthcare is sustainable.
The most troubling cases? Probably newly minted doctors, nurses, etc who have borrowed heavily to get their degrees assuming that their future income will easily cover the loan payments.
BTW, I suspect that Health IT people have a brighter short term outlook than long term. A lot more jobs in that field in 3 years than there are now. But not so many in 15.
Rumor has it the administrative rules for state health exchanges went to CBO Thursday or Friday.
Thanks VT, i could have made this a mile long so i hope this gives you the flavor.
So… in other words, Obamacare mainly preserves the worst apsects of the existing wasteful, care-denying, for-profit system intact, while lavishly rewarding the finance guys, executives and complexity-adding bureaucrats. Clearly a stunning “victory” for liberalism.
Heh, Congress should just allocate the whole $750B a year fiscal cliff payoff to Medicare and expand the program to everyone (improving its benefits such that Medicaid and Obamacare could be replaced).
In 2009, the CBO scored Anthony Weiner’s Medicare bill as needing an $1T a year in additional revenue. Let’s see, including the $150B a year added by Obamacare taxes (and Medicare savings) plus $200+B from eliminating income (and FICA) tax deduction for insurance premiums, the fiscal cliff would pay for it and it’d be a hell of lot easier to organize one marathon vs. organizing 50 simultaneous marathons.