The United States Health Care Delivery System in 2016

After watching the final Presidential debate of the 2016 election, one physician wonders where do we go from here?

As I was watching the last Presidential debate of the 2016 election season, it struck me that there was very little discussion about healthcare in the United States. Since the enactment of the Affordable Care Act in March 2010, reform has occurred at relatively slow pace. For patients, expansion of access to care for the uninsured, increased out-of-pocket costs, and a mandate to obtain health insurance have been the major changes. For small employers, increasing premiums, and increased overall costs of healthcare in relation to the benefits paid has been the mantra. For physicians, burdensome regulations for HIPAA, Meaningful Use, the Physician Quality Reporting System (PQRS), along with EHRs that lack interoperability, and a completely new value-based payment system have been rolled out over the last six years.

From my perspective, except for improved access to care for patients, healthcare in the country has become costlier without any improvement in quality for patients, small employers, doctors, and insurance companies. Since it appears that the grand experiment called Obamacare has failed, the big question for our country is what's next for healthcare? 

I believe that a failed Obamacare will limp along until the correct political alignment allows for the next significant change in healthcare policy. The failure of this pieced together pre-one payer system, will spawn a universal healthcare system where premiums are subsidized, copays and deductibles are waived for the least expensive treatment options, and utilization is tightly controlled through guidelines.

Obamacare's failure will bolster the supporters of a universal healthcare system arguments for tighter control that will result in less expensive outcomes, and lower cost to the whole system. For patients, cost of care always drives them away from individual responsibility for their medical care to the shared responsibility of a government system, which means universal healthcare.

Unless there is a straightforward economic solution from the private sector (which has not happened yet), my feeling is that our next healthcare system will be financed by one payer, the federal government. Maybe this grim outlook for the future of healthcare is the reason politicians won't talk about one of the most important issues facing our country at the time of any electoral decision.