Jeff Bauer Blog

Under normal circumstances, this post would explore how results of the latest presidential election will likely affect the future of health care—an analysis I’ve undertaken every four years since 1976.  I’m proud of my track record; the post-election forecasts have been generally consistent with subsequent changes in policy and practice, although I have tended to expect things to happen faster than they actually did. 

My approach to post-election analysis reflects the view of Murray Weidenbaum, a former chairman of the President’s Council of Economic Advisors: “The role of an economist is to dampen the enthusiasm of proponents of simplistic solutions.”  Big changes promised by candidates almost never translate into actions by those elected.  Evolution of the medical marketplace is decidedly incremental…and painfully slow.  (For an excellent case study of the complexities of health reform, read the chapter on passage of the Affordable Care Act in President Obama’s new book.)

I wish I could forecast the impact of last month’s election right now, but I cannot say much of anything about its implications, except that anyone who claims to know is making a SWAG (silly wild-ass guess).  Control of the US Senate—a critical variable—will not be known for at least another month, and transition to the Biden Administration will encounter lots of expected and unexpected roadblocks.  Then there’s the out-of-conrol pandemic, which will continue to wreak havoc on the delivery system and population health for years to come.  Add our overall economic crisis to the big picture, and the future could move in any number of unpredictable directions. 

As a health futurist, I traditionally spend December and January updating information on the four key trends that historically shape the evolution of American health care: health sciences, technology, the economy, and politics.[*]  The overall situation is so uncertain at this time that almost nothing can be said about the last three items on the list for foreseeable future.  However, Covid-19 is solidifying a game-changing trend in scientific knowledge that defines how health professionals should approach patient care.  The pandemic is revealing why precision medicine will become the new paradigm for 21^st century health care.

Medical practice in the 1900s was firmly based on a “one-size fits all” concept of disease and treatment.  (This is not a criticism of 20th century medicine.  The new paradigm was made possible by technologies that only became efficient and effective over the past 30 years.)  The medical system was designed to meet the acute care needs of individuals once they got sick or injured.  It was curative.  The new paradigm is preventive in comparison, managing the evolution of individual health problems so that they do not develop into conditions requiring hospitalization.  It also recognizes social determinants of medical problems and factors them into the dynamics of successful care. 

Precision medicine grew in popularity since the turn of the century, but some commentators have recently begun to raise questions about it.  However, I contend that Covid-19 is proving the value of precision (i.e., individualized, predictive, preventive) medicine in ways that will redirect evolution of the health care delivery system once the pandemic dust settles.  Clinical studies of the novel coronavirus clearly show that it is not one discrete disease which will ultimately be cured by a vaccine or drug.  Consistent with the precision paradigm, Covid-19 encompasses a variety of evolving organisms that express themselves in different ways in different types of patients.  Treatments must be customized to individuals; “one-size fits all” approaches won’t solve the problem.  The pandemic can only be managed successfully for our population when health policy and delivery systems are reshaped accordingly. 

As much as I am dispirited by today’s economic failures and political dysfunctions, I am optimistic that health professionals (not economists or politicians) will decide that Covid-19 is sufficient reason to restructure American health care around the precision paradigm.  I also forecast that many of the work-arounds developed in response to the pandemic will survive in the long-term because they are more efficient and effective than the processes used to produce health care in the 20^th century.  I’ve often argued that it takes a crisis to initiate necessary changes in American health care because “the powers that be” are so firmly entrenched and defensive.  Precision medicine as a new foundation of health policy could be the silver lining in an otherwise big black cloud.   

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Copyright 2020, Jeffrey C. Bauer