Futurist discusses health care costs and ACA ruling

June 26, 2012 Denise Pinkney

Millions of Americans are anxiously awaiting the Supreme Court ruling on the Affordable Care Act (ACA). Yesterday, futurist Jeff Goldsmith—someone who studies and predicts the future based on current trend—offered his thoughts on what the court might decide as well as the future of health care at an event in Fargo.

He thinks the most likely outcome is killing the mandate and the rest of the insurance reforms. The second most likely outcome would be to leave the law intact but to express "profound reservations."

Goldsmith is one of the nation's foremost health industry analysts.  He's the president of Health Futures, Inc. and an associate professor of Public Health Sciences at the University of Virginia. He's also lectured at the Graduate School of Business at the University of Chicago on health services management and policy.

He described the political climate as adverse to the Supreme Court sustaining the law and said the decision on ACA constitutionality is a legal decision "with political characteristics." The Supreme Court is expected to announce its ruling on Thursday. The second most likely outcome would be to leave the law intact but to express "profound reservations."

Rising costs of health care

"It's not cost growth that is the problem, but the absolute level of cost and the increasing inability of most people to afford it," Goldsmith said.

Goldsmith said half of the U.S. population is uninsured or underinsured (50 million Americans lack health insurance, 35 to 40 million Americans with coverage are unable to afford a major illness and 53 million are enrolled in Medicaid).

"Against that background, health plans have to be aggressive advocates for saving their subscribers money, not just paying bills," Goldsmith said. "How do I help them take care of themselves and avoid spending money they don't have?"

Using Kaiser Family Foundation monthly surveys, Goldsmith showed that the target audience for whom the Affordable Care Act (ACA) was to help is largely ignorant of the law's benefits and that subsidies will be available to them. He attributed the ignorance to the lag time between signing the law in 2010 and the implementing of its major provisions in 2014.

He told attendees at the luncheon sponsored by Blue Cross Blue Shield of North Dakota (BCBSND) and the Chamber that the Supreme Court isn't the most significant threat to ACA, the bigger issue facing employers and financers is the nation's $1.3 trillion deficit.

"The real problem is that health care costs too much, and an increasing number of people can't afford it," he said. "Health care remains unacceptably risky to patients." The Milliman Cost Index 2012 found the average American health coverage cost $20,742 in 2012 for a standard PPO plan. The family pays $8,584, which included out-of- pocket costs. That amount is equal to 41.7 percent of the family median income.

What to do
Goldsmith encouraged attendees to work to lower the risks and cost of care by improving efficiency and eliminating unnecessary care.

"We are a long way from recovery," Goldsmith said. He described the health care experience as too fragmented, with no accountability for results or cost.  As a result, he encouraged insurers to become matchmakers for their subscribers' physician relationships and for clinical solutions. Likewise, health insurers need to be advocates to help their subscribers save money and to improve their health.

He advised employers to involve their employees in cost decisions while being aware of their employees' economic circumstances. He also suggested providing worksite alternatives to ER use to reduce absenteeism.

What BCBSND is doing
As part of our commitment to find affordable solutions to improve North Dakota's health care system, BCBSND sponsors events that can promote discussion. We've already started work on some of the things Goldsmith mentioned. Our MediQHome program is one example of improving quality and making the health care system less fragmented. And we are changing our payment system to reward doctors and hospitals for providing the right care, at the right time.

Your thoughts
What do you think? Do you agree with the futurist's point of view? How do you think the Supreme Court will rule on health care reform?