Debate is raging about Obamacare, and not just in Washington. Out here in Oklahoma we're grappling with implementation of the Affordable Care Act. Patients. Employers. Hospitals. Doctors. Insurers. All of us.
Here then are one doctor's predictions about what we will see in the short and medium term for what I see as the unfolding Obamacare era — the biggest domestic health expansion since the enactment of Medicare in 1965.
1. Obamacare is moving ahead, Texas Republican Sen. Ted Cruz notwithstanding. Too many organizations, both inside and outside the government, have invested too much time and money to stop or reverse Obamacare's changes. We will look back on these defunding attempts as political theater.
2. Medicine has entered the era of big data. You'll be nudged regularly by your doctor, other health care providers or so-called medical homes to obtain recommended tests like mammograms, colonoscopies and vaccinations. Health plans will use statistics on flu shots administered and other elements of preventive care to boast about their efficiency and to jockey for market position.
3. Big data will lead to targeted marketing of medical services. Think Amazon or Netflix. If you take a medication or have a particular condition, you'll get offers and ads tailored to you as a potential buyer of related goods and services. The federal medical privacy law called HIPAA won't constrain this. HIPAA prevents doctors and hospitals from sharing protected health information with other entities without patients' (or their surrogates') permission.
But I think drugmakers and others could soon use general information about you to market their products, figuring that because of Obamacare you now have insurance.
4. Patients will be a step closer to becoming true consumers. There will be more price transparency for health care as demand increases, but not enough to fully bargain shop. As a consumer, you will have more opportunity than ever to express your opinions — through focus groups, consumer boards, and online surveys.
To me, this is one of the most exciting aspects of the health care overhaul. As an industry, we flunk the customer service test again and again. Too often it's the patient's voice that's heard least when it comes to quality improvement.
5. More people will get insurance. The 47 million uninsured will be cut in half within four years, it seems to me.
6. By 2020, all states will have expanded their Medicaid pools, providing more coverage to the poorest of the poor.
7. The number of nurse practitioners and physician assistants will grow dramatically. Nurse practitioners will continue to gain more independence in practice. A new category of health worker will flourish: the community health worker, a lay combination of social worker and medical provider. In particular, community health workers will help with the 5 percent of people who account for half the health care spending in the U.S.
8. We will see the rise of the first nationwide health plans. Archaic rules that keep health care local will be modified to eventually allow for consolidation. Like hotel chains, you'll be able to get health care at the same organization in different cities. The sponsors may be hospitals, say the Cleveland Clinic, or big health insurers, like Aetna. As with hotels and airlines, you'll have frequent visitor programs, and you'll be able to amass points toward discounts and perks.
9. The traditional doctor-patient relationship in which a single doctor gets to know you over years will become a luxury. Those who want a personal physician will have to pay extra for that service. Doctors who chafe at the notion of working for big organizations will opt out and choose direct service models, with patients paying them retainer fees.
This last one is the saddest aspect of all our changes, and for me will be the the hardest to accept. It's distasteful that what most of us have taken for granted is likely to become a perk for the privileged few.
John Henning Schumann is a primary care doctor in Tulsa, Okla., where he teaches at the University of Oklahoma School of Community Medicine.