And that it really is bipartisan. (Picture from the Rutgers School of Law in Camden, New Jersey.)
The two parties are not Republicans and Democrats. They are business and government. The people who pay the bills demand change, so change will come in 2010.
Changes have already been baked into the system, partly through insurers responding to the demands of their biggest customers, and partly by government actions taken in the last few years.
The most important reform is moving from a fee-for-service to a per-patient fee model. Businesses know that wellness and prevention pay dividends, that all their insureds need some services every year to minimize disease later on.
Whether we define your risks by your genes, family history, or lifestyle, we can take steps while you're healthy to keep bad things from happening to you. And this costs less than treating you later on.
The second step, which was assured as part of the HITECH Act embedded in the stimulus package, involves getting the data.
With the passage of new rules defining meaningful use, and the creation of "beacon communities" that will model responses to the data, the ingredients for health care transformation are already in place.
That is, we'll find what works, what the low-cost communities are doing, and we'll use that as a model to drive change in other communities.
That's a lot harder than it sounds. Many of our health cost drivers are based on business relationships, like the conflict of interest inherent in doctors owning hospitals and imaging centers. Those will not be broken easily, even when the need to break them becomes obvious. There are vicious fights ahead.
The debate that continues in House-Senate conference next week is really just about who pays for it. It's not about reform itself.
Will we continue the same arrangement we have now, large businesses paying the bulk of everyone's care costs, government paying for those that can't pay, and consumers squeezed in between? Or will we switch to a new model in which everyone has an obligation to pay, perhaps with government aid, perhaps through government mandate?
The debate pits those who are now being subsidized -- small businesses, conservative states -- against those now paying most heavily -- large businesses, taxpayers, healthy middle class consumers.
Reform itself is already coming.
- We will know what your health risk factors are, and push you to reduce those risks.
- We will create wellness programs that help you with issues of diet, exercise, and drugs.
- We will monitor everyone's true health care costs with technology, and try to do what WalMart has done, changing the system in response to data.
All this will just bend the cost curve a little bit. Harder choices still need to be made:
- Bulk purchases, like those made by the Veterans Administration, to squeeze suppliers.
- Mandated changes in lifestyle, which is what most individuals fear most.
Bulk purchases could come from vertical integration, letting insurers buy their own hospitals and clinics, or contracting for services with low-cost providers like WalMart and CVS. Or it could come from government negotiating more closely for its own supplies, and pushing people toward generics instead of new drugs and treatments.
However it's done it is going to happen. This is the story to watch in 2010. The verdict of voters this November won't matter as much as you think.
Businesses can't afford your fat, drunk, smoking butt any more. If you won't follow your New Year's Resolutions this time, ways must be found, carrots and sticks, or we have to buy your care in bulk.
This post was originally published on Smartplanet.com