Recently the California Health Care Foundation was lucky enough to host an in-depth presentation by health care futurist Ian Morrison. Ian is an internationally known, California-based consultant and speaker specializing in the future of health care and the changing business environment, and he's also a former CHCF board member. On September 27, Ian regaled our staff with insights and commentary on "The Future of the Health Care Marketplace: Progress and Promise."
In his talk, Ian's health care assessments were impressive, authoritative, and valuable. Here is one of my favorite slides from the more than 100 he presented during his CHCF talk:
Later I interviewed Ian about the comparative health policies of Hillary Clinton and Donald Trump and about the future of Medi-Cal. Here's what he had to say (a transcript follows each of these two short videos):
Transcript: Comparing Clinton and Trump Health Policies
MORRISON: Well, I am not much of a futurist, because I've agreed to speak to the Medicaid directors of America the day of the election. And I think it was kind of a dumb idea, because the election will be hugely consequential for Medicaid.
If Mr. Trump is elected president under Republican control of the Senate and House, then I think it's quite conceivable to see one path for Medicaid which will be basically cutting coverage, and I don't think the Congressional Budget Office is wrong when they estimate that if the Trump plan were to be implemented, we'd probably see the uninsured go back up again by some 20 million, basically losing all the gains that had happened under Obamacare. So I think that's a likely option if a Trump administration were to prevail.
I think if Hillary Clinton is elected president, and there's a chance that if that were true there would also be a change in the Senate, then I think you could see some action on a number of fronts. One of the fronts would be expanding . . . you'd see more states, perhaps, capitulating and expanding Medicaid, which would be a very significant shift.
And I also think there would be attention, potentially with some bipartisan support, to fix, finally, some of the deficiencies in the structure of the Affordable Care Act with regard to exchanges and how they function and the rules around that. So I'm hopeful that if that were to happen, there might be some positive change with regard to the lingering issues and that we might finally put Obamacare fights back to the back burner.
I tease my Republican friends that the war against Obamacare is now officially longer than America's involvement in World War I and World War II combined, and it just seems to be about time we got over it.
Transcript: The Future of Medi-Cal Innovations
MORRISON: Well, I've been a believer for a long time now that Medicaid is a key building block for our future. A lot of people point to it as a failed program, but it is larger than France in terms of its enrollment, and in a recession under a Democratic administration, could grow even larger still.
Over 72 million Americans are in Medicaid right now. Now, Medicaid covers a lot of different people of different classes — of categories, I should say — which is including the dual eligible and children and blind and disabled and some categories. But nevertheless, it's still a significant portion of insurance for low-income folks.
And I think it's very, very important that we figure out a sustainable delivery model for Medicaid, sustainable financially but also in terms of quality and service and responsiveness.
It can't be a second-tier program. It needs to be one tailored to the needs of vulnerable populations who may have special needs because of their income or because of their health status. And I think that will require innovation. I think it will require innovation of scale and new thinking about how to deliver health services that perhaps combine much more social work and social services than pure medical services.
And I think imaginative ways to conceive of new ways of delivering care, which might involve transportation alternatives. Or it might involve work alternatives or counseling alternatives that don't really look like traditional medical services.
And I think there's some great experimentation going on, but the key is to harness those experiments, evaluate them carefully, and really drive appropriate innovation through the large systems who are capable of pulling this off at scale. And I think the Foundation might be in a very good position to help lead and galvanize that effort.
For more information on Ian's perspectives, see his website and watch another video.