There’s been a lot of discussion about reforming our health care system over many generations and presidential administrations, and most recently in the run-up to and immediate period after the election of Donald Trump. Republicans promised for 7 years to repeal and replace Obamacare only to (so-far) fail miserably at walking-the-walk. I believe the political milieu, is at best a red herring, innocuous and really noise. The fact is the value movement that we’re talking about in health care is really a market movement. The proverbial train has left the station and market principals are already starting to disrupt the industry.
The government could start to rein in program increases, and transition higher income seniors into a cost- sharing model. Medicare could create a reference-pricing catalogue, allowing market participants to leverage the massive purchasing history of the program. Privatizing Medicare would enhance competition among private insurers who, in turn, could build exciting new collaborations with physicians and community-based providers. Such a move will also profoundly impact the delivery system. As Medicare represents a sizeable portion of many physicians' book of business, a migration of that segment to a value-based construct will have a jarring – though positive – long-term effect on physician practices. Medicare will represent the “tipping point” for many community provider organizations that decide they now have an opportunity to practice under a market-oriented system.
Even with the promise of value-based care, the variability in adoption of value-economics by clinicians is still quite broad; forcibly moving the ~ $600B Medicare program to a private market would drive hundreds of thousands or providers to change their respective business models very rapidly.