I don't think there is a solution that will satisfy everyone. We're not going to be able to stabilize all 3 pillars (cost/quality/access). Well, no one country has been able to yet, and I don't think our political environment puts us in a position to be the first.

I think comprehensive legislation for healthcare is about as stupid an approach as there possibly could be. But recognize that our political environment wouldn't support a long-term, well though out, piece meal process for HC legislation. But that's how we should do it. Individual legislation on each pillar, each one implemented over a 2-3 year span to limit and react to the unintended consequences that arise. Do it in whatever order you want, though I think cost should be the foundation for the other 2.

Functionally, it has to be a dual private/public model of delivery. I think a public option, though not ideal, is inevitable. I think the big 5 will reduce down to the big 2 or 3. And I think you will end up with 3 seperate healthcare markets.

The public option patients that will deal with rationing, long waits, foreign medical grads and mid levels, and an extremely tight network. FFS providers will be phased out of this market in favor of shared risk and value based payment models with public health systems. I think your commercial patients will have access to the larger, private health systems and hospitals thorough a national insurer or through corporate sponsored plans that contract directly with private docs and health systems. I suspect both FFS and shared risk models would be used. These plans will mostly be employer sponsored. And I think you will see another surge of concierge and subscription based medical practices come to fruition. This would naturally be the most expensive option, but its already a fast growing niche in private practice. And when you compare the total annual expense of a subscription based practice to your current annual Health insurance expense, its not that drastic of a difference. It's a good option for diabetics and other with chronic conditions that require maintenance.

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And does that align with the majority of your professors?

The majority of my professors, except for the former hospital CEO that was my mentor, believed we would have already passed single payer legislation. The ACA was/is a disappointment in their eyes. Like I said, they were big proponents of The CommonWealth Foundation.

This post was edited on 7/19/17 at 4:21 pm