For the healthcare industry, this is the most consequential election in history.

- Paul Keckley

We sat down with Paul Keckley, healthcare policy analyst and managing editor of The Keckley Report, to talk deep thoughts about American healthcare trends, politics and policy. Here are seven of Paul’s most poignant points:

Healthcare is the fastest growing line item in federal, state and household budgets

“Healthcare is 29% of the federal budget, it’s up to 35% of a state’s budget, it’s 14% of a household’s discretionary spending, and the fastest growing line item in all three. So we built a system that doesn’t force anybody to say, ‘How much is this going to cost and who’s going to bear the brunt of that?’”

There isn’t a law that requires employers to provide healthcare

“So what would happen if employers said, ‘To hell with it? I just want to get out of this altogether. I don’t provide auto insurance. Why should I provide health insurance?’ So employers are amassing their influence to address this issue of the economics of healthcare are not sustainable.”

“So what would happen if you were buying healthcare and everything was an individual purchase decision? Would that market evolve better over time?”

60% of the population’s healthcare is already covered by the federal government

“If you take Medicare, Medicaid, federal employees, veterans health and military health, and put in another couple million of Indian health if you want, you’ve got over 60% of the population covered by the federal government today. That doesn’t include what will happen through these exchanges — the marketplace, activity in the states — which may end up being the individual insurance market.”

We have two options: consumer market or federalized system

“Let’s create a consumer market for healthcare and let people choose. The problem with that is it doesn’t address the five percent of the population that are sick, really sick, and will never be able to afford to buy health. So you’d have to create some catastrophic pool. But [that five percent] represents almost 40% of cost.”

“[Another end game is] you just say we’re going to federalize the system. The federal government will make the rules, and you can buy outside the system if you want.”

Doctors would have to choose between private and public in a federalized system

“Doctor can’t say ‘I’m in the public system, but then this afternoon I’m going to see some private patients.’ You’re in or you’re out—no different than private education. You’re paying taxes for public schools. But if you choose to go to Vanderbilt, that’s fine.”

Our healthcare system will not look the same four years from now

“It’s not a system. It’s a collection of sectors that operate their own businesses and feed at the same trough.”

“I don’t think, four years from now, regardless of whether it’s Trump or Biden, the system will look like it does today.”

“We have to connect the dots between public health, preventive health and the private system. They operate in separate universes.”

The biggest change on the horizon

“One system-ness. We have to connect the dots between public health and preventive health in the private system. They operate in separate universes. And ironically, this is the policy’s part of this. Most of the funding for public health comes from state and local government. Most of the funding for the healthcare delivery system is federal…”

“COVID isn’t going away soon, and there’s an economic reality that we can’t afford the system we’ve built. Has our psyche about healthcare changed as a result of COVID? I think so.”

Curious for more? Listen to the full conversation with Paul here.

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