Sunday, August 24, 2008

A Look at Healthcare in 2019

The Institute for Alternative Futures (IAF) has launched a new project to look at the changes needed for future healthcare needs in this country. In 2009, the new administration will face the challenge to change healthcare in America. In looking ahead, IAF is working on a series of nine papers covering the 10 year change process necessary to stimulate the ideas that are needed to begin this process.

The project “Healthcare That Works for All”, when completed will discuss nine interrelated aspects of healthcare to occur by the year 2019. The papers in the series that are currently available cover values for healthcare, health economics, and the changes needed in the payment and delivery systems. Future papers will relate to healthcare issues such as science and technology, political changes, policy, infrastructure, and social and economic conditions.

The paper on healthcare payment systems in 2019 envisions a redesigned healthcare payment system that would require:

  • A combination of private and public options covering the population, but with limits on third party obligations that define a basic tier of care that is constrained by value-based purchasing
  • Government funding of an open source network to assess the comparative efficacy of treatments, and how this would shape reimbursement policy
  • A new Independent Health Board that would propose annual national health budgets that would only be increased by Congress through higher taxes or designated shifts from other parts of the federal budget. The board would first conduct a public referendum with randomized surveys so that the priorities represented by healthcare are democratically reinforced
  • Regulators would continually monitor for unanticipated rises in costs that would lead to swift adjustments in policy or recommendations to CMS for regulatory action. As spending trends move upward, the Health Independent Board would propose changes

Futurists envision sufficient incentives and protections being offered to encourage the widespread use of electronic medical records and personal health records. The infrastructure will support a host of incentives for provider teams to coordinate care and improve quality. Procedures and information will be communicated so that it will be possible to readily navigate payment systems with the help of continuously improving software aids. Also evaluation tools to link healthcare inputs to health outcomes would need to be developed.

Most Americans would continue to get their healthcare insurance through employers. Others would have the option of buying insurance from other organizations using regional risk pools that cover people with pre-existing conditions with transportable covers. By 2019, all individuals would be mandated to have healthcare insurance so that the basic tier is available to all. The cost of this basic tier would only be allowed to increase at the rate of growth of the GDP. Individuals, who want more than the basic tier of care, would be able to pay out of pocket or buy supplemental insurance. However, tax incentives would only support the basic tier.

For questions and comments on the papers, contact To download the papers, go to