The Outlook for 2011 in Health Care

Today's date, 1/11/11, suggests a contrived approach to blogging about the New Year -- like predicting the one big change to expect or the top eleven predictions for 2011.  However, my crystal ball view for this year is not precise or symmetrical.  It is very cloudy.  In my 40+ years of full-time work in this business, I have never been more uncertain about the near-term future.  Health care could go in several different directions this year, and it almost certainly will.  We need to be prepared for the simultaneous occurrence of seemingly contradictory outcomes.  One of my favorite Oriental sayings sums it up nicely: "Things are not as they seem, nor are they otherwise."

If you are likewise confused in your own thoughts about the immediate future, I believe you understand what's going on.  Nothing makes sense.  Health care's leaders do not have a roadmap to follow because there's no consensus on where we want to go and how to get there.  The country does not have any identifiable leaders who have a persuasive vision and the power to move the health system in a clear direction this year, and I certainly do not see any political or economic forces that suggest rational convergence is on the horizon.  Rather, I foresee unraveling (but not repeal) of the health reform laws due to shortfalls in appropriations, plus exemptions from the laws to the point that exceptions will be the rule.  And the annual increase in health spending -- down to 4% last year -- will fall even further due to serious structural problems in the economy.  We are approaching zero growth in the medical sector.  The underlying problems are likely to be solved in the long-run, but not in 2011.  The wild card is constitutionality of the health reform laws.

My perspective on the future is undeniably shaped by formal training in economics, with its theoretical assumption that the "higgle and joggle" of the marketplace will move us toward desirable equilibrium.  The philosophical question that divides economists is how much the process should be managed by government vs. how much it should be left to the "invisible hand."  Because our political system is broken, I think that providers, payers, and purchasers need to lead the way in setting the nation on a better course and reallocating resources to move us in the right direction.  My crystal ball doesn't suggest that this will likely happen in the next 12 months.  I hope I'm wrong.  Yet, as another Oriental sage once said, "Surely, we will end up where we are headed if we do not change direction."  Can anything be done to start pushing us in a good direction in 2011?

Forecast and Resolution for the New Decade

The infosphere has been full of predictions and resolutions for 2011, befitting the start of a new year.  Curiously, I've seen nothing to recognize the simultaneous arrival of a new decade.  The ten year horizon is much more interesting to me as a futurist, so here are my initial forecast and resolution for the new decade in health care.

The first task is naming the decade.  I propose "Crisis Teens," using crisis in the medical sense of a turning point where a life-threatening problem can get better or worse.  If the health care system in the U.S. were a patient, it would be in the critical care unit with a diagnosis of systemic failure and an uncertain prognosis.  The latest therapy (2010 health reform) isn't offering any realistic hope to improve the nation's health, and changes in the underlying circumstances of 2011 (Republican control of the House, legal challenges to the reform laws, increasing income disparity) suggest a strong possibility that the therapy will be withdrawn.  With no miracle cure on the horizon, the outlook for health care is uncertain at best and gloomy at worst.

This is not necessarily bad news.  Uncertainty can offer hope because it means that outcomes are not predestined.  Thoughtful, purposeful responses to anticipated changes can make a difference.  Consequently, my forecast for the coming decade is a range of outcomes (that is, successes and failures).  Many health care organizations -- particularly progressive, open-minded partnerships of providers, payers, and purchasers that recognize the need to work together -- will develop successful responses to the new circumstances.  Comparable numbers of organizations will either fail because they are not capable of adapting to new circumstances or will survive, barely.

For organizations desiring success, I propose the following New Decade's Resolution: to design an integrated health system that works, and then build it sooner rather than later.  Health systems with a good future will generally adopt a creative "do-it-yourself, now" approach that recognizes the enormous risks of waiting for politicians to find a viable solution later.

If anyone has a better suggestion than "Crisis Teens" to characterize the new decade -- or a different interpretation of the circumstances that will define it -- please reply with a comment.  (While you are at it, the past decade still needs a name.  The best suggestions I've seen so far are the "naughts" or the decade of "lost opportunities," and both explain the mess we are in today.)  I know from my first career as a weatherman that the best forecasts emerge from open discussions leading to clarification and even consensus.  A healthy debate is the key to a better understanding of the future and what we can do about it.  What are your forecasts and resolutions for health care in the new decade?