There’s a movie coming in April called “Hanna.” Looks like a mashup of the Bourne Identify, Ender’s Game, and Blade Runner. Or maybe not. What caught my eye when I saw the ad for this movie in the Los Angeles Times Sunday was it’s tag line: “Adapt or Die.”
I don’t know how well “Adapt or Die” describes the movie, but it certainly describes the reality facing stakeholders in America’s health care system. And it would have whether or not the Patient Protection and Affordable Care Act has passed or not. Lawmakers and regulators at the state and federal levels are far from done with their revisions, tweaks and changes to the PPACA.
Nonetheless one thing is for certain: the status quo (the health care reform system as we knew way back when — a year ago) is going to change dramatically. Even if the PPACA were to be thrown out as unconstitutional (a very unlikely outcome), the way we were is gone. Republicans recognized this when they changed their battle cry from “Repeal Obamacare” to the mantra “Repeal and Replace.” No one wants to go back to the “old” system. Republican driven health care reform would be different than what Democrats passed, but it would still require stakeholders to adapt to a changed world. Republicans support exchanges. They support requiring carriers to accept all applicants without underwriting. They want medical malpractice reform, but their cost containment ideas go far beyond reducing the volume of law suits.
Even more significant, the American people don’t want to go back to the way things were. They like the idea of increasing the portability of coverage, eliminating pre-existing condition exclusions. Many support increased government oversight of premiums and regulating carriers use of rescission and the like.
The result is that everyone involved in the system will need to adapt:
- Carriers will have less flexibility when it comes to setting rates, underwriting, and benefit designs. They may face new competitors – some with an unfair advantage created by skewed playing fields. As the “old” ways of competing are limited, the importance of offering providing strong value and superior service will become a more important differentiator. Which means carriers will have to do more with less – provide more and better services while spending less to provide those services.
- Brokers need to develop a business model that accommodates reduced and more transparent compensation. I’ve been warning for several years that, even without the PPACA, commissions based as a percentage of premium – premiums that were rising at the accelerated rate of medical inflation as opposed to general inflation – was unsustainable. The PPACA means this transition to a new compensation model will come more quickly, but it was coming nonetheless. At the same time brokers will need to powerfully communicate and demonstrate their value, which means a greater emphasis on post-sale service, services that no government bureaucrats can deliver. Add to this the reality that agencies will need to diversify their offerings and brokers are in for a tumultuous time of adaptation.
- Providers today are in an enviable position: they set the demand while simultaneously providing the supply. OK, enviable might be overly stating it, but they are in a favorable position – for now – enabled by the dominance of a fee-for-service payment structure. So long as as doctors and hospitals are paid for doing more rather than less, regardless of the outcomes, they will be tempted to do more, a temptation that will be even stronger given the reality that law suits are not often brought because providers provide too much care. The PPACA contains demonstration projects, pilot programs and other elements aimed at encouraging a greater focus on the outcome of medical care, as opposed to the volume of care, patients receive. The reform law also encourages the creation of a more integrated care system, changing the way providers practice and the relationship between doctors and facilities.
- Employers were one of the loudest voices calling for change. Health insurance costs were devouring resources and profits, eroding their competitiveness, and distracting executives’ attention from their core missions. If health care reform, as passed, actually reduced health care coverage costs employers might be rejoicing. But the PPACA all but guarantees higher premiums while also imposing greater regulatory burdens on businesses large-and-small. The exchanges might offer a refuge for some businesses, especially very small businesses, but if history is any indication they will be far from the panacea their advocates (which include both Democrats and Republicans) promise.
There are other stakeholders: pharmaceutical companies, state and local governments, and consumers to name a few more. But you get the idea. America’s health care system needed to change. Consequently, those impacted by America’s health care system would need to adapt. This doesn’t excuse or justify the elements of the PPACA that do more harm than good.
As Congress takes up health care reform yet again, it’s important to keep what’s happening in perspective. Some modification of the new health care reform law is inevitable. Lawmakers, regulators or the courts may dramatically alter the PPACA. Regardless of whether the revisions are large or small, the one certainty is that we’ve passed the point of no return: the status quo is history. Which means we all will need to adapt or, if not die, at least move on.