2014- The End of the World Again?

The Shakers believed the world would end in 1792 (so why have kids?). People affiliated with various religions have predicted the end of the world many times. The latest end of the world prediction focuses on December 21, 2012, based on the Mayan calendar.

End of the world predicitons trigger fear, skepticism, and debate. In health care we have our own “end of the world” scenario for 2014: the federal health care reform calendar brings mandated health care exchange system implementation. Various authors and experts identify doomsday scenarios that frankly seem plausible: employers may drop employees from employer funded health care coverage; states may or may not participate in the health care insurance exchange system; contrarians hope that litigation or politics will kill or modify healthcare reform. 2014 is certainly triggering interest, fear, skepticism, and debate. And that’s interesting (but probably not interesting enough to trigger a disaster movie with colossal special effects like “2012″ released in 2009).

The next two years will yield interesting challenges as we all ponder whether US healthcare reform will survive legal challenges, become broadly implemented, overwhelm health care providers with demand in excess of capacity, and/or lack sufficient resources to fund mandates. With Medicare reimbursements scheduled to drop, and health care insurance reimbursements unlikely to increase, we are entering into a period of ongoing uncertainty as to how or where US health care will evolve. Since US employer funding of employee health care significantly contributed to the development of insurance-based medical services delivery, the advent of US employers lawfully dropping employee health care coverage seems cataclysmic.

Meanwhile, there is still a growing quiet revolution in US preventative medical care as private or fee-based primary care interest continues to surge. Whether framed as “concierge” or “boutique” or “private” the concept is relatively straightforward: patients pay something out-of-pocket toward preventative medical care that exceeds what Medicare or health care insurance can or will deliver.

With 2014 on the horizon, will private medicine grow, or stagnate? Fear of the unknown is likely to contribute to an increase in private medicine subscription. Why? Government seems to lack sufficient revenues/resources. Insurance seems unwilling to fund. Employers seem to struggle with containing health costs. That leaves patients to fund patient preventative care in excess of what plans provide. So as 2014 approaches on the federal health care calendar (assuming the world exists after 2012), many will seek private medicine solutions now to avoid what they fear US medicine may look like in the next two years.