There’s Actually A Lot Of Good News

Many healthcare executives and professionals are wary, glass-half-empty people, conditioned by long experience to dwell on business risks. However, today’s healthcare environment is actually full of good news. Reflect on the following:

Expanding coverage. We’re on the way to cutting the number of uninsured Americans in half. No, we didn’t get to universal coverage with the Affordable Care Act, and its implementation has not been a pretty sight. But after decades of political failure, tens of millions of Americans are receiving coverage, no longer having to postpone care for serious health risks. Hospitals are already seeing their uncompensated care decline rapidly, especially in those states that expanded their Medicaid programs. 

Cost crisis abated. We’ve achieved durable health cost stability. Since 2008, health costs have grown only 3.6% to 3.9% per year — growth rates not seen since the Eisenhower administration  The Congressional Budget Office recently forecast that 2016 per capita Medicare spending would be almost 30% lower than they projected in 2006. 

Declining deficits. As the nation’s economic recovery enters its sixth year, declining budget deficits and far-below-forecast Medicare spending has reduced the pressure on Congress to improvise hasty new spending cuts. Pressures to cut Medicare to balance the federal budget are lower than they have been in years as a result of the cost-crisis abatement described. This also means that there is less pressure to implement new Medicare payment schemes before there is evidence that they actually work.

Value, not just cost. Policymakers, business and insurers alike are finally talking seriously about value, not simply cost. This means there is firmer ground for health systems that can unify their clinicians around value improvement. We may not get all the way to population health management in this round of payment changes, but new benefit designs and better transparency of clinical quality measures will finally help to create a market for the high-value provider that has not heretofore existed.

Improving hospital-physician relations. The seemingly endless cold war between hospital management teams and physician communities appears to be thawing in many places. This trend is harder to measure, but my impression from extensive travels around the country is that a lot more hospital management teams and medical communities are working constructively together than in the past. There is fruitful collaboration on implementation of clinical information technology and on new payment models. 

Cure for a dread disease. We’ve actually cured a major viral chronic illness: Hepatitis C. Usually the words “cure” and “disease” appear in the same sentence only in fundraising solicitations for universities and foundations. Hepatitis C was an emerging human and cost disaster, with nearly 3.5 million people infected, including many baby boomers blissfully unaware of their problem. The new Gilead drug Sovaldi is very expensive, so expensive that its present pricing of $85,000 for a full course of treatment probably will not hold. But the costs of terminal liver disease prevented by Sovaldi will be enormous.

Declining mortality from acute illnesses. We’ve also made a major dent in heart disease as well as cancer and stroke. Age-adjusted mortality from heart disease, the No. 1 killer of men and women in the United States, has fallen 34% since 2000. Cancer death rates have fallen 17% in the same period, and stroke death rates by 39%. While the steep declines in cardiac mortality in the 1980s and early 1990s have been attributed to far more effective hospital-based care after myocardial infarction, my cardiologist colleagues believe that this more recent, steepening decline can be attributed to the widespread use of statin drugs.

Some potential harbingers of bad news:

• An economic downturn could place new pressures on the federal budget

• New or resurgent infectious diseases could also expose the gaping holes in our present antibiotic drug defenses and infection control systems

• If we encounter shortages of health care workers, there could be a resurgence of wage pressures that could reignite hospital costs

But, for now, there is more good news in our health system than we’ve seen in a long time. Enjoy it while it lasts.

Jeff Goldsmith is a healthcare futurist. A version of this article originally appeared on the Health Care Blog.