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A Few Hopes and Predictions for 2019

A Few Hopes And Predictions For 2019

While many say hope is fleeting, I offer a few hopes for the New Year. At the same time, the pragmatist, or some might say cynic, in me offers some predictions that may not dovetail well with the more optimistic side of me.

Obamacare

I hope for movement to solve the Obamacare crisis – Readers of this blog know that we are pretty level-headed about the need for affordable access to healthcare. We think the current construct that the Democrats developed is too rich and unaffordable. At the same time, we recognize that truly affordable access to healthcare is critical to the health and long-term prosperity of our nation. So, notwithstanding a divided Washington, we hope that the parties can get together to solve the crisis. Millions of Americans now rely on either Medicaid or the Exchanges for coverage. Millions more are still shut out of affordable access due to the poor design. Lawmakers and President Trump, set politics aside and come together on a sensible solution.

I predict continued partisanship that means no action – Unfortunately, it is hard to predict anything but gridlock on Obamacare repair. Democrats are unlikely to want to compromise in the House. The Senate has fewer moderates going into 2019. While presidential leadership could force compromise, we don’t see the President going this route despite recent predictions for the “great healthcare” coming. The “Medicare for All” effort will not take on steam for the same reason (not an unreasonable outcome, either). If there is any progress on the affordable care front, it might be tied to the bipartisan support for Medicare Advantage (MA) that exists and all that has been accomplished on the cost and quality front in the program. MA is the place to be and could be a model for our healthcare future – rationale government regulation and private sector innovation. Still, there are reasonable fears of breaking something that is running so well.

Drug pricing reform

I hope for some rationalizing of drug prices – Notwithstanding relatively moderate drug price increases the past few years, the fact is that drug prices overall are unaffordable for many Americans. The reasons for this are multi-faceted – from foreign price controls to sinister practices by drug companies to America as the biggest consumer and profit center for pharmaceuticals. With a divided Washington, we would hope that at least on this issue the parties could get together to rationalize the system and at the same time ensure ongoing innovation in the industry. It would be a complex, multi-dimensional puzzle worthy of solving.

I predict the strong likelihood of some reform – With the President up for re-election in 2020 and his affinity for the issue, Trump and Congress should be able to overcome differences and pass at least some legislation on this front. It is likely to center on Medicare costs at least for now, which could be broadened in the future to all insurance products.

Long-term care

I hope for progress on building an affordable long-term care continuum in America – The aging of America is creating a huge economic burden for American families and the nation as a whole. More and more are being forced into nursing home institutionalization when cheaper alternatives exist. As with drug pricing, I hope that the parties can get together on building a long-term care continuum for the nation, one that keeps seniors out of nursing homes and in the community, one that is cost-effective and quality driven. Models are out there.

I predict action – Health and Human Services Secretary Alex Azar has said good things of late on this issue. He wants to combine healthcare and non-healthcare spending to build an innovative system. If there are two “soft” issues Trump could endorse going into his re-election, they are drug spending and long-term care. There is a conservative budgetary angle here. Democrats love this social safety net issue, too.

Healthcare Consolidation

I predict continued vertical and horizontal consolidation in healthcare – 2018 saw noticeable consolidations and mergers. While some of the biggest names gobbled up others or merged, we will see continued activity on this front. Some of them will be unexpected “Aha!” moments as people smarter than us see hidden angles of growth and innovation out there. We will likely see more technology firms getting into the healthcare game as Amazon did in 2018 with the purchase of PillPack. Technology can help streamline and bring efficiency to our healthcare system that is strangely both monolithic and labyrinthine. We also expect the three Wisemens’ (Jamie, Jeff and Warren) effort to bring quality to the commercial health insurance world take fundamental shape in 2019.

Hopes vs. Predictions. We will see. Happy New Year!

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