2020 Already, How Did That Happen?

I know, I know, the way I write you would think I am just a spring chicken, but the sad truth is I am old, really old.  Still, every now and then I am startled by how much time has passed.  I remember the Y2K scare pretty well and now that was 20 years ago.  I guess you have to be happy to be alive for whatever length of time, and the longer you live supposedly the more you should learn and the wiser you would become.  I have worked in health care for over 40 years in one capacity or another, including as a front-line nurses aide.  When I look back at all that time, I am not sure what lessons I would take or what has changed all that much.  American health care is a strange mix of characteristics.  The actual quality of the health care people get here is very high quality–very modern, not really rationed in any meaningful way, good access for any one who wants it.  Sometimes that quality gets lost in the poor health and poor health behaviors of many Americans.  Those behaviors make it hard to look good on many common measures of supposed quality.  Health status is not the same as health quality.  The policy decisions that would improve health behaviors are very different from those that affect the quality of actual health services and products.  And we have been completely unwilling to implement policies that would affect health behaviors, because these might be viewed as punitive, and gosh, we wouldn’t want to hurt anybody’s feelings or anything.  So looking forward, don’t expect the health behaviors, and health status, of Americans overall to improve much.

We also have an expensive health care model, but that is because Americans like to make money and improve their economic situation.  Doctors get paid a lot, and why shouldn’t they when they have heavy student loan burdens, have all kinds of administrative and regulatory burdens heaped on them and live in constant fear of malpractice suits.  I don’t know anyone who really wants to make less money.  Our hospitals charge very high prices, partly because they are staffed by managers and employees who want to make a lot of money and because we all as patients expect them to look fancy and have all the latest equipment.  That isn’t cheap.  I don’t expect any of that to change anytime soon either.  Drug prices are excessive by any measure; we all know that, including the manufacturers.  Will 2020 be the year stronger action is finally taken on drug prices?  I doubt it, the lobbying and campaign contribution machine will be even more important as we go into a presidential election year.  Consolidation of providers clearly plays a role in high prices, and frankly, lowers quality.  Will 2020 be the year we get action on that front.  I don’t think so.  If those kind of fundamental issues can’t be addressed, I would expect health care spending to muddle along, growing at a rate faster than the economy, but not completely out of control.  And people will continue to be stressed and fearful about their share of that spending.  So pretty much status quo.  And, oh yeah, you will continue to hear all kinds of hype about apps and digital health and population health management and artificial intelligence and social determinants of health and none of that will make any difference either.  Happy new year, new decade, meet the new boss, same as the old boss.  Believe it or not, I am actually a pretty happy, cheerful person, but I have become more realistic in my expectations as I have aged.