Yes, he was a U.S. presidential candidate front-runner in the 2004 election, a three-time governor of Vermont who was thrust into office after the death of his predecessor, and a very capable doctor. But this is really about his view as an active board member of Extendicare and a former health care innovator who was first to accept block grants, creating universal health care for all children, that makes his predications more interesting to reflect on.
Here’s what you need to know, or the ‘news you can use.’ Governor Dean’s talking points were:
- Brutal Decade Ahead: Dean believes LTC has a brutal road ahead in the U.S. that will be a challenge to survive because there will be medical malpractice problems in many states, along with MCO raiding Medicaid, corporate oversight being overzealous, no real seat in ACO frameworks, very tired assets, ALF Medicaid funding expanding, etc., all of which will force a large percentage of skilled nursing closures. We are stuck in the middle, we are a hybrid, and this is the roughest ride ever. ACO will get control and then where do fit in? Are we running out of time?
- End of Employer-Sponsored Health Care: The recent Obama Care legal ramifications really are telling us this is the end of employer-sponsored HC because consumers will buy good insurance related to deductible, limits, costs, etc. with $2k penalty per consumer. Employers will force exchanges and set up programs to move them out, all low-end businesses will move to exchanges, etc. Once heath insurance is taken direct to consumers, all relationships will change.
- Two points to remember… he acknowledges that Fortune 500 organizations can afford to operationalize wellness and do it well, but that it’s not a reasonable value proposition for most employers going forward. Secondly, consumers can buy health insurance well, historically, based upon their personal needs better than an employer, and the HC exchanges can offer deeper discounts once closed networks are established.
- Large, established hospital systems are mostly non-for-profit, so they have less financial pressure and can think long term more than publicly-traded insurers. They also have access other funding sources and are more mission based, so they can accept lost leaders as needed.
- Competition through HC exchanges finally takes off, which is much better because it will be free market competition (he likes HC exchanges that are wide open, where it offers discounts for closed access, lifestyle, patient engagement, etc.).
- Secondly, many physicians are too emotional toward their patients to make great evidence-based decisions, but as providers assume total risk. They will be a reliable gate keeper who becomes less generous than the government, but not as punitive as MCOs.
After his talk, I wanted to catch some one-on-one time with him, just to thank him for a spirited discussion and open forum. He was gracious with his time, helping give me some counsel about the limits of politics that frustrate him – but why the policy work makes it worth it – and discussing his current work as a visionary teacher as well as overseas mission work.
He also wanted to know more about the Signature Revolution, which I believe intrigued him. Maybe having a clinician for a President may not be such a bad idea after all.