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Radical Incrementalism or System Re-Design: Which Way Forward for U.S. Healthcare?

"The U.S. healthcare system is ... caught between the tyranny of the present and the possibilities of its future.... [I]ntramural conflicts, financial incentives that often reward short-term results and a structure that's flawed limit its potential.... The current state is not sustainable. We have perfected radical incrementalism. We defend it vigorously with three worn barbs: patients don't want it, physicians will resist it, and radical change is impractical, especially when the incumbents are strong and the status quo is profitable. And we fight the entry of outsiders who dare invade our turf."

Is the Amazon, JPMorgan, Berkshire Hathaway Venture Armageddon for Healthcare as We Know It?

"The new venture will focus on the collective buying power as employers of healthcare for the 1.15 million employees in their organizations. Their approach features five strategies widely used by large self-insured employers to contain their employee health costs. This one is expected to leverage technology in a unique way[.]"

The Eight C's That Will Define Healthcare in 2018 and Beyond

"Costs ... Capital ... Consolidation ... Consumerism ... Competition ... Compliance ... Culture ... Certainty ... Next year is pivotal to the future of our system of health.... Every board and management team in healthcare will be tested."

Medicare for All: The Two Issues It Must Confront

"The U.S. debate will center on two issues: the relatively high prices we pay for the drugs, devices, technologies, services and facilities we use, and the medical necessity for many services provided for which evidence shows no benefit. What happens to innovation if the federal government uses its muscle to ratchet down what it pays for services and who decides what's necessary or not? And what's the administrative expense necessary to managing our $3.4 trillion expenditure? ... The issue will be whether and how primary and preventive health will be elevated in a U.S. single payer model and how specialty and long-term care are impacted long-term."

Health Insurance Availability: Is Choice the Real Issue?

"Healthcare consolidation is the result of economic reality: the private market in healthcare is shrinking, the public market is growing and choices for consumers are fewer. And the public market is not as profitable as the private market, so access to capital and positive operating margins are increasingly achieved by fewer and bigger organizations. And that means fewer choices for consumers in choosing with whom they'll do business."

Re-Thinking Employer-Provided Health Benefits

"Employer-sponsored coverage is shrinking.... What's covered and who is covered is shrinking.... Employees are paying more of the cost.... Employers blame hospitals and drug companies for excess costs.... Employers are implementing new strategies to rein in their costs.... Two issues have regulators' attention: Disparity in employee access ... Contracts with providers ... But beyond these issues, cost is the overriding employer concern that's likely to define the future for employer sponsored health benefits."

An Open Letter to the Senate HELP Committee

"[T]he individual insurance market is only 4% of the 285 million who are insured.... The stability of individual insurance market is a legitimate issue but it's small relative to policies and strategies that impact every employer and household. Your charter must be bigger than reducing risks for insurers; it must be about the viability and sustainability of the entire health system."

Changing Health Insurance Plans Again: Seriously?

"Tackling the individual market for insurers is only part of the issue facing insurers: flaws in the ACA's oversight of insurance extend beyond the individual market. [1] Insurers have no obligation to provide coverage to any segment in the population if it's not profitable to their businesses.... [2] Americans want coverage but most don't trust insurers.... [3] Large Insurers have done well since passage of the ACA despite its flaws, while others have been hurt."

Winners and Losers in the Senate Healthcare Bill, and Four Themes Not Addressed at All

"Four themes have been missed in the rhetoric on both sides: [1] Access to insurance coverage is not the same as access to care.... [2] There's plenty of money in the system, but much is wasted and it's not spent in the most productive ways.... [3] The Medicaid program needs transformation: budget cuts without program re-design does nothing to fix it long-term.... [4] Affordability has not been addressed."

The Healthcare System: 50 Years Later

"In 1967, the healthcare system was an abstract concept. We paid scant attention unless we wrecked our cars or injured ourselves playing ball. We thought every physician infallible, every procedure evidence-based and every admission necessary. But today, healthcare matters and how our system operates confronts them daily. There's confusion about Repeal and Replace and dissonance about the politics: they understand healthcare is expensive but they think there's plenty of government money to cover anyone needing care."