|No matter how we misread poorly designed polls stating otherwise, single payer and public option health plans were not going to pass Congress in 2009-10, and the people were not going to clamor for same in large enough numbers to demand their legislators' attention.
What is most important in learning to walk is taking the first step, no matter how halting, shaky and bound to fall down and go bump...but the future requires nothing less than taking the first step forward.
Here's my prediction: by 2030, healthcare will be entirely socialised, either through national integration of delivery or a series of locally integrated systems. Obamacare is just the first step in that inevitable direction (and the process will continue regardless of who wins in 2012 or if Obamacare is repealed in 2013). Obamacare forces insurance companies to limit premium increases. This will impact the way in which medical care is delivered to the insured populations. Already, we see a trend towards hospitals becoming insurance companies, insurance companies buying up physician practices and an overall consolidation within a business model that is irrational: peoples' lives at stake while the currently disparate parts of the same system (hospitals, drug companies, physicians, medical device makers) all compete against each other to maximize their profits, thus driving up costs as the patient becomes a mere statistic on the bottom line.
"Integrated healthcare delivery" is what they call it. I call it the US version of nationalising healthcare inside locally-based, privatised pods built around hospitals and physicians. The lines between the special interests which today account for so much adminstrative wastefulness and padded profits to the detriment of us all, will blur and the system will soon enough become either a truly nationalised integrated model like NHS, or remain a privatised version controlled by government regulation and oversight.
And yes, she who controls the levers of government will control the direction of the healthcare system. Same as it ever was.
Soon to come will be limits on how much hospitals (the main cost driver, along with Rx drugs) will be allowed to charge for services (similar to current Medicare payment policy), and an enforced (as opposed to voluntary) ethical guideline for the way in which physicians practice and treat patients.
Today, there are already many physicians who get it. One is a friend of mine, a Canadian by birth and medical training who runs a lean family practice clinic capable of treating 60-70 patients per day during regular business hours, with only a registered nurse (not a nurse practitioner, either) in support of him.
How does he manage it? First, he is there for his patients at all times of the day and night, seven days a week, not just for those 8 minutes in the exam room. They all have his personal cell phone number and are encouraged to call him anytime. Literally. He answers his phone at 3:30 in the morning. Surprisingly, the good Doctor reports that patients are respectful of his time and privacy and few if any abuse the privilege he extends them.
Second, he doesn't overtreat, oversubscribe Rx or testing. He listens to complaints, he follows a cautious approach and he encourages patients to get involved in their own health between visits by making notes of their symptoms, recording changes between office visits and emailing the notes back to him the day before they return for the next appointment. If they cannot email they bring the notes with them. If they are illiterate, they are encouraged to include their children/grandchildren in the process. If they are illiterate and have no participating children/grandchildren, then the doctor allots them more time during their appointments so he can gain an understanding of their symptomology since the previous visit.
Unsurprisingly, this physician is now on the radar of major national insurance companies, at least two of whom have offered to acquire his practice in exchange for his teaching them the secrets of his successful primary care management of nearly 3,000 regular patients.
He makes an excellent living for himself in the process, although he lives rather modestly and carries none of the "I am God, therefore do not speak to me unless spoken to first by me" demeanor of so many physicians.
The new era of medicine will be accomplished either through additional legislation aimed at private insurance companies/hospitals/physicians/Rx companies/device makers or the creation (finally) of Medicare for all. It may take 15 more years, but it is as inevitable as the end of the non-Latino caucasian majority in this country.
The practice of medicine will change tremendously during the next two decades, as will much else in our technologically fungible environment, forced by the economic impact of cost reductions through Obamacare (on Medicare mostly, but private insurers who more and more administer Medicare plans will follow suit in their "commercial" or group insurance plans) and the transition to a system that is based less on reacting to symptomology and increasingly on a wholistic wellness approach (Obamacare pays 100% for annual physicals) to the individual's physical condition, aided by technology and yes indeed, by ever increasing and creative uses of the internets!
The younger generations coming along, who may as well have social media and I-pads implanted into their neurological circuitry, will respond to the new organizational structuring of medical care delivery through telecommunications by becoming connected to healthier nutrition, exercise, moderate habits and encouragement to interact with the health system as represented by the family physician, at least in comparison to today's generation.
My doctor friend uses I-Pad extensively in his practice. He has yet to make the leap into social media, or connecting with his patients by blog, providing them a forum to explore healthcare issues, nutrition, etc. But we have discussed these potentials often, and its only a matter of time (and economic incentive to do so, which is also an experiment under PPACA) including opening an exercise center next to his clinic, which will be offered free to his patients who commit to a workout regimen along with nutrional classes. counseling and other pro-active steps toward healthy minds and bodies.
These are initiatives aimed at the children primarily, because his practice is located in a relatively poor socioeconomic area where parental free time is at a premium and blogging is far down the list of necessary activities. But the kids. Everything we do today must be for the kids. No one accepts this dynamic more than the so-called "illegal alien."
May our antecedents live to be 150 years of age or more!