A "Medicaid for all" public option where the primary care will be provided by masses of mid-levels or foreign medical graduates. The specialty care will be significantly rationed and wait times for care heavily increased. Large public and public/private health systems , with networks of local clinics, will provide that care at a discounted rate in exchange for the economies of scale from these "public" patients.

"Private Insurance" will be primarily catastrophic in nature, with the first $2000-$6000 of paid money always coming from the insured. Networks will be extremely restricted, and will likely include many of the same health systems as above, but with larger for-profit hospitals participating as well. Think Methodist, Memorial Hermann, CHI, etc.... I think there will always be contracts between these guys and whatever private insurers survive the implementation of a public option, which may be as few as 2, IMO. But people with this insurance will always have to stay within their system. Choose whatever physician you want, but only within this tight network. And the premiums will still be high for this coverage, similar to what we've had the past 5 years, and what we have coming in the next 5 years.

Any physician group with <5 docs will (have to) become concierge based. Come see us, and I'll arrange your bloodwork, imaging, treatment, medications, etc... I can do anything in house except hospitalization, so most concierge patients will likely hold a catastrophic insurance policy of some sort. There is already a growing market for this, and it will only become bigger in the next 5 years.

Private docs still holding out will eventually sell to a health system or change business models. There will be a few "favored" health systems that end up with the public option contracts. And your Methodists of the world will still do well with tighter contracts and administering their own insurance to their employees and subsidiaries.

IMO.

This post was edited on 8/5/16 at 1:29 pm