What’s the Long-Term Vision for Health Care in America?

(This is an unedited transcript. For accurate quotes and presentations, please refer to the full-event video.)

Margaret Murray:

Hello. My name is Meg Murray, and I’m the CEO of the Association for Community Affiliated Plans, otherwise known as ACAP, as well as a proud member of the Alliance for Health Policy. At ACAP we like to say that Medicaid is us. And by that I mean we’re the leading association advocating for Medicaid and Medicaid beneficiaries, and the safety net health plans who serve them.

Margaret Murray:

Because of our strong support for Medicaid, one of the main things we’ll be working with the new Congress and the new administration is to make sure that there’s adequate funding for Medicaid, particularly during the pandemic. We will be looking for the new Congress to support increased FMAP during the pandemic, as well as to have a trigger, so that the Congress has already decided that FMAP should be increased the next time we have an economic cataclysmic event like we have right now.

Margaret Murray:

We will also be working with the new Congress and the new administration to end the proliferation of junk insurance. The current administration has allowed these plans to be sold for up to three years. We believe that many beneficiaries will be snookered into buying these, which do not have all the protections of the Affordable Care Act, and we want to make sure that consumers are protected.

Margaret Murray:

So, that’s what we will be working for with the new Congress and new administration and I look forward to hearing the discussion today.

Sarah Dash:

Hello, and welcome to the third session in the Alliance for Health Policy 2020 Signature Series, Post Election Symposium. I’m Sarah Dash, President and CEO of the Alliance. And for listeners who are new to us welcome. We’re a nonpartisan resource for the health policy community, dedicated to advancing knowledge and understanding of health policy issues.

Sarah Dash:

Thanks for joining us today, where we will continue to grapple with the devastation of the ongoing COVID-19 pandemic, and how the election results could influence the health policy agenda in 2021 and beyond. Since the election news and results are still updating, please note that we’re recording this on Monday, November 16, at 2PM Eastern, in case anything has changed between now and when we broadcast.

Sarah Dash:

I’d like to take a moment to thank our 2020 Post Election Symposium sponsors for supporting this event. And I also would like to highlight our upcoming session where we will discuss the gaps in our healthcare system that COVID-19 exposed, and how that will impact the priorities of the incoming administration, Congress states and federal courts.

Sarah Dash:

You can also find recordings of yesterday’s discussions on our website and materials that accompany all of our sessions at allhealthpolicy.org. And now it’s my pleasure to introduce Dr. Ian Morrison, a New York Times bestselling author, consultant and futurist, specializing in long-term forecasting and planning with an emphasis on healthcare. Dr. Morrison currently serves as senior advisor to Concord Health Partners and on the Advisory Council of the Council of Accountable Physician Practices.

Sarah Dash:

Dr. Morrison has previously served as president of the Institute for the Future, and is the founding partner at the Strategic Health Perspectives, which is a joint venture between Harris Interactive and the Harvard School of Public Health Department of Health Policy and Management. Prior to his time at Strategic Health Perspective, he served as the chairman of the Health Futures Forum.

Sarah Dash:

Well, Ian, we’re so grateful to have you here today to provide your insights on what you think we can expect next year and beyond, and with that, I will turn it over to you.

Ian Morrison:

Well, Sarah thank you so much for having me, and it’s an honor to be with such distinguished faculty and a wonderful program. As you mentioned, I’m known as a futurist. My definition of a futurist is an economist who couldn’t handle the calculus. I’m in the sweeping generalization business and have been for a very long time. And the number one question I always get asked is, how do you become a futurist? I point out that my undergraduate major at Edinburgh University was geographic and economic change in Scotland 1580 to 1830, which is incredibly useful.

Ian Morrison:

But actually, it’s a useful training. I’ve been a student of structural change in society now for almost 50 years. And I ended up working in healthcare, ironically, I was trained as a geographer, an urban planner, moved to Canada, and then was working on my doctrine and I got offered a job to join the Institute for the Future, modestly entitled Institute for the Future, to work on a grant called Looking Ahead at American Healthcare that Bob Blendon when he was at Robert Wood Johnson had given the institute. And I got a chance to work with Bob in 1985 and pretty much ever since. And we have been close colleagues and I’ve learned so much from Bob Blendon over the years.

Ian Morrison:

But I’ve spent most of my time in the last 20 odd years working with health systems and healthcare stakeholders across the spectrum of the ecosystem and i continue to do so. And I wanted to share some comments about where I see the industry, and particularly the impact of healthcare, or the impact on healthcare of the COVID pandemic. So, if we can go to the next slide.

Ian Morrison:

I’ve been a student of the post-industrial economy now for 40 odd years. And if there’s one hallmark of post-industrial society, it’s the widening income gap between haves and have-nots, particularly the top 1%. I say to my kids, “Be in the top 1%, you’ll do just fine.” But these effects are also compounded by race and racism here in the U.S and in many other countries. Next.

Ian Morrison:

And when it comes to healthcare, if we look at the next slide, the one kind of mega trend if you like, that we’ve been watching over all the time I’ve been in the U.S, which is now 35 years, is the progressive unaffordability of healthcare, particularly in terms of out-of-pocket costs.

Ian Morrison:

I mean, the American public in my view, could care less how much it costs as a shared of GNP, but they worry about what they pay. And one tracer condition that, I was on the board of the California Health Care Foundation for a decade and we did a little study back in the day that showed that in 1970, if you provided health benefits for a family, it would cost about 10% of the minimum wage.

Ian Morrison:

Today, that equivalent number of health benefits for a family is 150% of the minimum wage, which really speaks to the progressive unaffordability of healthcare. Next please.

Ian Morrison:

And I mentioned the California Health Care Foundation back in 2005, Mark Smith, the then CEO, I was on the board and Mark invited me to join a meeting with Ulla Schmidt who is the German minister of health through much of the early 2000s. And she was on a listening tour, trying to understand how American healthcare works, and Mark and several others were gathered to talk about trends in American healthcare. And we got to the point in the conversation about money. Oh, by the way, she didn’t speak any English, which was a bit difficult. But actually, she had this translator guy, that simultaneous translation, so we actually got along fine.

Ian Morrison:

And we’re in the part of the conversation where we’re talking about the money, and I was explaining and waxing lyrical that the way it works in America is that doctors in hospitals charge some multiple of what actually costs to deliver the service maybe two or three times as much, to make the math work, because of the perceived underpayment by public payers. And I don’t speak German, but I believe she said, “What the f…” Expletive deleted.

Ian Morrison:

And she’s right, because if you go to the next slide, one of the hallmarks of American healthcare has been our different pricing level relative to other countries and over time. And there is this widening gap now between what private payers pay and what public payers pay, and you can debate all day long about it’s cost shifting, it’s not cost shifting, it’s real, and it’s a phenomenon that really underlies the financial engine of American healthcare. Next please.

Ian Morrison:

So, I would say and having been an advisor to large employers over the years, most employers are kind of complicit in this game, they’re not thrilled about it, but they don’t really do much to stop it, with some rare exceptions where they’ve massify their firepower or use their influence to create narrow networks. And the question is, will they stiffen the resolve here in the post-pandemic period, as they have been hit hard many of them in terms of their own core businesses. Next.

Ian Morrison:

What I would say is that, if I had to give a talk about trends in healthcare prior to the pandemic, the top trends really were the kind of confluence of what I just described, the rising commercial prices and financial gotchas in things like surprise billing, which by the way is not bug feature of certain business models like emergency room physicians who have been rolled up by private equity firms.

Ian Morrison:

The second mega trend was the growth of Medicare Advantage, which I think has been one of the engines of the value movement in American healthcare, as has managed Medicaid, and of course Medicaid expansion in the wake of the ACA, was the fact on the ground I think that really expanded coverage.

Ian Morrison:

But similarly, what we’ve seen prior to COVID, and I think will actually accelerate and perhaps even become a bigger force, is consolidation in the healthcare delivery system and the market power that it creates. And I say inevitable, partly because of not so much that it’s a good idea to consolidate, but that a lot of weaker players may capitulate.

Ian Morrison:

And there is a massive amount of money prior to the pandemic and even through the pandemic being invested in private equity and venture funds in healthcare, particularly in consumer facing digital health, but not exclusively in that area.

Ian Morrison:

And in the political realm and the policy realm, there have been prospects for Medicare for more, I wouldn’t say Medicare for all necessarily, of the fadable blending on that. But certainly, the possibilities in a Biden administration had there been a substantial Democratic Senate Majority of a public option for many Americans and an expansion of Medicare to a younger age ranges.

Ian Morrison:

And I would say that value-based care is why we call a stalled future. It’s not that we don’t believe in it, and certainly, I’m an advisor to the Leavitt Partners and a great fan of Governor Levitt and his team, and share the commitment and belief that value-based payment needs to be the inevitable goal of healthcare. But most of the action, I believe has been in Medicare and Medicaid rather than has been in the commercial, particularly self-insured employer space. And that remains the frontier to be tackled.

Ian Morrison:

And of course, many health systems across the country we’re responding to new consumerism movement in healthcare, and I’m trying to create a digital front door. And I believe that there is a force for productivity in healthcare, through the rising promise of artificial intelligence. And I think that may be one of the things that will bail us out in the long run, in both the clinical area with innovations like dermatology or surgical pathology, imaging ophthalmology, pattern recognition done both with and enhanced by computers, as well as in the more administrative area.

Ian Morrison:

And the final mega trend I’ll point to is the whole area of physician burnout. And I think burnout is the wrong term. I mean, everybody works hard, right? Clinicians like to work hard. I think that the sense of alienation and frustration that many folk feel and demoralization in the face of unnecessary administrative hassle factors, has been a big driver. And this is obviously become more intense post COVID because of the sheer terror legitimately that many caregivers face every day in the face of dealing with patients who are sick and infected. Next please.

Ian Morrison:

And maybe just a couple of data points behind the sweeping rhetoric. It’s interesting to me as a person who as a fan of Medicare Advantage that we have seen, even in the Obama years with Democratic administrations, we’re not as gung-ho about Medicare Advantage, we saw continuous growth, and I believe that certainly my colleagues the Leavitt Partners, that they believe that this will grow materially over the next decade, regardless of national policy.

Ian Morrison:

The other counter trend is Medicaid expansion even with Republican administrations, and even in the Trump years, we’ve seen states expand Medicaid, most recently in Oklahoma and Missouri who are not noted as being hotbeds of socialism, and yet vast majorities of their population voted to expand Medicaid. Next please.

Ian Morrison:

So, COVID brought challenges to the health system and continue to do so. We have been obviously trying to focus on stopping the spread, and I’ve had uneven results in that. I think we’ve done quite well in serving the second learning how to do better. I’m not a clinician and that would be pertinent of me to weigh in on that. But certainly, some of the success stories have been remarkable in terms of being able to get the fatality rate down.

Ian Morrison:

But the real challenge I think remains how to balance the economic issues with the clinical pandemic. And it has proven very difficult not just here in the U.S but around the world and starting economic recovery. And I think most people have done it somewhat prematurely and have had to reassess their progress. Even my native Scotland in the last month or so was basically shut down again. Next please.

Ian Morrison:

And of course, the challenge really, and certainly the president, through the early part of the year was focusing much more on the rebound from the precipitous drop that took place in the economy in the first six months of the year, historic drops in jobs, if you go to the next slide, what we saw was basically all the jobs created in the last 20 years disappear in two months, which was massive and impactful across the board. Next.

Ian Morrison:

But we have seen significant recovery since then we’re down to about 10 million jobs year over year, unemployment rate has bounced up to 6.9%, but it’s higher for women and it’s higher for minorities. And alarmingly a significant proportion of those who are now unemployed, have been out of work 27 weeks or longer, which is always a bad indicator for not only the income of those households, but the social determinants of health that result. Next please.

Ian Morrison:

And so, it is important to consider where we go with regard to jobs, not the least of which is, will it cause us to reassess our commitment to using employer-sponsored coverage as the backbone of American healthcare? When you think about it historically, it’s kind of an accident that we do it this way, and my colleagues around the world think it’s a goofy idea. It was hard to explain to people in Glasgow why that would be so, an underserve cruel cartoon. By the way, it’s a fine and dandy idea when the unemployment rate is 3.7%, and everyone’s got job with health insurance, which is not necessarily the case.

Ian Morrison:

It’s not so fine and dandy an idea when the unemployment rate is 10%. And I think one of the things I’ve been looking for over the last six months is a change in public attitudes, and a sense of vulnerability, the public may feel about their employer-sponsored coverage. Next please.

Ian Morrison:

And I do want to point out that this pandemic, not only in terms of jobs but in terms of the impact on the actual clinical outcomes including deaths and hospitalizations, have disproportionately affected the folks who take the early bus, and we’ve seen it bounced back in income. And those of us who Zoom for a living are relatively unaffected, and doing very nicely, thank you.

Ian Morrison:

Those of us who live off capital rather than labor have done very well in the last year. But if you are a bus driver, or a hotel worker, or work in a restaurant, that’s not the same story. Next.

Ian Morrison:

And sadly, this has been, as I say, compounding the effects of race and racism show up in these alarming differences in mortality rates and impact by race. Next.

Ian Morrison:

So, my colleagues and I, we worked on some scenarios back in March to try and describe the arc of what may happen. And I won’t bore you with all the details, but we’ve used these to judge the unfolding reality. And they’re really cartoonish. I mean, they had data behind them and assumptions, but let me just describe them in cartoon form, because I think they are sort of instructive of the arc of the year so far.

Ian Morrison:

The big bounce back scenario was I think what many people were hoping for, which was, it was a one quarter event, much as it was in China, and we killed off the virus and we got back to normal. Well, that clearly hasn’t happened, except in two places. One is the stock market, which has bounced back and is ahead year over year. And the other is actually the health system, which I think has bounced back quite remarkably in the last three quarters, even though it’s been hammered by the pandemic in many ways.

Ian Morrison:

The second scenario was really presaging perhaps a blue wave, where the American public felt progressively insecure because of the pandemic and would vote for more faith in government to resolve those issues. And to some extent, that scenario has prevailed with president-elect Biden’s election, although there are counter currents in the fact that there was a very significant vote for President Trump and the Democrats didn’t gain massively in either the House or Senate.

Ian Morrison:

The third scenario is a bit like scenario one, only it takes a little longer, and we may eventually get to that new normal later on next year with the good news about vaccines. And I do think that the difference between scenario three and one is not only that it takes longer, but that some things will be different. And I do think in the long run, people are going to be more cautious about mobility, we’re not going to travel as much quite yet.

Ian Morrison:

Scenario four is like scenario two, it’s Biden administration with no money, right? Because one of the big overarching problems post-pandemic, is that the federal government is three trillion plus debt deficit, sorry, adding to the national debt with a cumulative debt over 100% of GNP, that’s not a terrific place to be.

Ian Morrison:

And so, this scenario was really around a willing administration without the ability to do anything. And that’s certainly true at the state level. I mean, I’ve been cruelly saying that people are defunding the police or the Senate, in the sense that there seems to be not much action in terms of bailing out particularly blue states at the state level.

Ian Morrison:

Scenario five, I have to credit my daughter who’s an epidemiologist by training and versus a consultant, but she lives in Seattle, and I asked her at the beginning of the pandemic what’s going to happen, and she said, “Well, they’re going to close it down, and then they’re going to open up again, and then they’re going to have to close it down again.” And she’s actually been dead on. That’s what’s gone on, not only here in the U.S, but in many parts of the world.

Ian Morrison:

And mercifully, it looks like we’re seeing scenario six, which science will save us, all of us I think hoped and prayed that we would have results from the massive investment in vaccines and in the science generally, and that the news of the last week or two has been very promising.

Ian Morrison:

However, I would say the converse of that scenario was scenario seven, which we didn’t even like to describe, which was civil unrest and no effect of virus. And I have to say, I think the next 60 days are going to look a bit like scenario seven, where we’re going to have people going to Thanksgiving, a third of whom say they’re going to meet as if it’s normal. And there is no vaccine in the arms of humans quite yet. And this false sense of security may compounded with 160 to 200,000 cases a day, will lead to a very ugly period over the next couple of months. I hope that’s not true, but I fear that it might be. Next please.

Ian Morrison:

And so, just in closing, I’ve been trying to think through what are the no matter whats of all of this. I do and I’ve always believed as many of my colleagues do that science will save us, we just don’t know when, and it looks like there may be hints of normalcy by the back end of next year.

Ian Morrison:

I actually believe that unemployment is still going to be down for some considerable time, and I’m not alone in that. I think the Federal Reserve believe that too. And I’ve gone out on a limb in saying that January 2020 was probably the all time high of private insurance in America. Because if you look forward, demographically the economy is good at generating low income jobs that require subsidy for insurance. And also, you’ve got this aging society where more and more are actively on Medicaid, Medicare sorry, and that potentially could have access to through policy changes.

Ian Morrison:

I think Medicaid coverage is likely to grow in any scenario. And that further as the virus has exposed the financial hydraulics of American healthcare and the overall dependency on procedure oriented fee-for-service surgical in particular, activity to make the math work for all providers.

Ian Morrison:

And I do think there’s going to be high anxiety amongst patients and families, not only about healthcare, but also about travel and other industries. If there’s a positive in the pandemic, it’s been the amazing speed and resilience people have used to pivot to digital activity, not only in health, but in all areas as evidenced by us gathering in this format. And I only hope that we don’t just pave the cow path as we futurist like to say, of just replacing visits with televisits, but rather use this moment to do a fundamental redesign of healthcare clinical processes and to enter, and be much more rich in their digital mix going forward.

Ian Morrison:

And one last slide I believe. Yeah. Thank you. I would hope, and you’re going to hear from our distinguished panel coming up. But I would hope that we take this moment in our history to pivot towards a longer term future that is more based on value-based payment models and principles, that we take this chance to redesign our care processes to embed more digital mix in telehealth and virtual care. And that we rethink and integrate better funding of public health, behavioral health, social services and healthcare going forward.

Ian Morrison:

I’ve long believed as people like George Halvorson have, that the end game for American healthcare might look like something on a bipartisan basis, that you might turn Medicare Advantage for all, supported tax finance, but having elements of competition, would be a unique American healthcare system. I think there is still a possibility of that, but certainly, in a polarized and divided country, it’s hard to see how that happens in the short run. But with the great leaders you have, Sarah, I think if anyone could pull it off, it’s America.

Sarah Dash:

Well, great. Thank you so much Ian, and that was a real tour de force of really a lot of insights. And so, I’m really excited, now we can get into a little bit of Q and A. I want to start with what you talked about here in terms of advocating for the opportunity to take a fundamental redesign of clinical processes. And I wanted to just acknowledge something about the pace of change. I mean, no matter what we think of this pandemic, the upheaval and pace the of change has been tremendous in terms of just like the rapid adoption of telehealth and those sorts of things. But at the same time, as you pointed out, the whole value agenda has crept along.

Sarah Dash:

Given the financial challenges that are facing providers right now, given the statistics you mentioned about, just the incredible wage gaps that we have, how that’s going to translate to coverage, and then how that’s going to then translate to the differential between public and private payment rates. I mean, how do providers, and I’m speaking very broadly here about providers, how do they take that stuff? What’s their incentive?

Ian Morrison:

Well, I think that’s a key question. I mean, since the pandemic has been raging, done a lot of advisory work with health systems and particularly large physician groups too. And what I would note is that those who had value-based payment models, whether they be capitated or in some kind of prepaid arrangement, I’m thinking of my friends at Kaiser obviously, but also folks like the Henry Ford Health System in Detroit who I worked with recently. I mean, those payment models prove resilient through the pandemic.

Ian Morrison:

But there is a counter trend where most American healthcare still predominantly playing the game I described at the beginning, right? On a fee-for-service basis. And what I also see, as my joke about, we’re not moving from volume to value, we’re moving from volume to volume, from inpatient volume to outpatient volume. And I have to say, I sit through these board retreats, and they’re celebrating massive increases in utilization when they occur, right? So, there is an addiction if you like, to that fee-for-service engine.

Ian Morrison:

But you mentioned another point, I think it’s critical. And I have been in actually, reverential all of the leaders of many of these large hospital and health systems across the country. The resilience that they have shown, and the speed and agility they have shown. I mean, I’ve been a critic of the industry for 30 years, and always teasing them that they move at this speed of glacial erosion normally, but they’ve actually, in many instances done 20 years of innovation in 20 days. It’s been really quite remarkable. And I just hope we can make that time clock of, hurry up offense a little bit more permanent in our health system.

Sarah Dash:

Yeah. And how do we take that? I just want to follow up on that point. 20 years of innovation in 20 days is pretty remarkable. What mechanisms are there? How do we learn from that? How does the health system translate that into something that sticks?

Ian Morrison:

Yeah, I think that’s the key thing. I mean, I did a panel with a number of CEOs just a few weeks ago, where all of them in their own way described that transformation resilience and stressed obviously, that part of it was building a culture of decision making that was much more rapid, that they hope to make permanent. But they also, I think these leaders who have been around a while, recognize that you can’t be constantly in panic mode. Battlefield medicine was what we were practicing in many parts of the country at the height of the pandemic, and presumably right now with some of our colleagues in the Midwest, and we feel for them.

Sarah Dash:

Yeah.

Ian Morrison:

But we can’t keep that pace up forever. And so, I think it’s balancing on the one hand a renewed sense of agility, and on the other not to stress or overstress your people and your organizations.

Sarah Dash:

Yeah. So, on that point, you mentioned as three of your mega trends, physician burnout, consumerism, and AI. And you even mentioned, you think AI has a really important role to play here. Is there some kind of coalition that, not a formal coalition, but I mean, is there a world in which the angry consumers that they want the more convenient care, the providers that are just exhausted, and the technology can come together and in some way help to advance our health goals in this country?

Ian Morrison:

I think that’s a very positive framing of what could happen. Here’s the challenge. Historically, healthcare has proven immune to technology improving productivity, right? If anything, technology has made it more expensive, not less expensive. And I think AI represents a real, and I’m not talking about replacing doctors, I described clinical AI as Hamburger Helper for doctors, it makes us scarce resource go farther, right? But that can enhance productivity dramatically. And where there are potentially massive improvements.

Ian Morrison:

Because remember, we have the most bureaucratic health system in the world, right? In terms of people in offices faxing things to each other. I think there can be dramatic improvement through AI in the administrative processes, both internally and throughout the health ecosystem, so that we don’t have armies of people doing revenue cycle for example. And I think that’s where we could see significant improvement in productivity in our institutions.

Sarah Dash:

Yeah.

Ian Morrison:

And you mentioned that the third piece which is, consumers looking for cheaper solutions, are maybe going to settle for chatbot services as a front end of primary care. And I’d watch for that, there are a number of entrants both domestically growing and entering from other parts of the world, who potentially should could revolutionize the economics of primary care using AI.

Sarah Dash:

Yeah, thanks. And you said something which we don’t hear a lot, which is fax machine. And maybe we just need to ban fax machines as a starting point and then-

Ian Morrison:

The fax machine should have been our business 30 years ago. So-

Sarah Dash:

[crosstalk 00:33:28].

Ian Morrison:

… they use mostly fax machines. They have to teach students in medical school how to use a fax machine, and none of them have ever seen one.

Sarah Dash:

That seems like a waste of time. So, I want to also ask you about the health inequity. I mean, you started off by talking about the income inequality, which has only worsened as a result of COVID and the way that the economy has turned. Obviously, we’ve seen these huge inequities. I mean, how do you think we’d begin to find our way out of that and towards a better future?

Ian Morrison:

Well, I mean, I can just give you one example. I’m proud to serve on the board of the Martin Luther King Hospital in Los Angeles, which came back from being closed in the early 2000s, for a bunch of reasons it was rebuilt and reformed and reborn, to serve the community. And I have to say, Elaine Batchlor, our CEO and the team have done a stunning job through the pandemic, in responding to COVID that we were probably 60% COVID at the height in July, and have weathered that storm, and even though there is a bit of a resurgence the last week or two, but I would say there’s that…

Ian Morrison:

MLK is an example of investment by federal state local government in providing a beacon of quality in an underserved community. And I think we need to think more imaginatively, like I believe we have a MLK on the leaders who created it, to find a new way to bring resources to underserved communities that lift them up and give them hope for the long run. I think it’s going to happen one community at a time, but we need a national policy that encourages them.

Sarah Dash:

Yeah, thank you. And I just want to do a couple more questions. I mean, one, you talked about Medicare Advantage for all as maybe being a very long-term end game. And we saw this in the debate, we saw that the Medicare for all model was was obviously roundly defeated in Democratic primaries, but we have such a discomfort still in this country, or we have just not settled around the proper role for public and private. And personally I think if we learn anything in COVID, it’s just like the importance of both sectors. I mean, you see it with the vaccine development, you see it with the efforts both on the ground with the public health departments and then with private sector efforts which we’re going to talk about a little bit on our next panel.

Sarah Dash:

I mean, how do you think the public sector and the private sector respectively, need to step up to meet this challenge?

Ian Morrison:

Right. Well, I mean, I think the great Bob Blendon would probably say that one of the distinguishing differentiation between the red and blue teams is their belief in the role of government, and the ability of government to pull stuff off. So, I think we are more divided than any other country I’ve lived in or studied in that measure. But the belief in government Canadians, I’m married to a Canadian, my son was born in Canada, I have a lot of family members in Canada. I would saying, Canadians are different from Americans, they described themselves as unarmed Americans with health insurance, right? But they believe in government more, and the power of government.

Ian Morrison:

That’s why I hope that we can find some common ground around something like Medicare Advantage for all because it concedes to the other side, that on the one hand, universality is important, and on the other a role for competition and the private sector has a legitimate role to play, and that those are ideological decisions that a divided country have just got to get over and find a way to work together.

Ian Morrison:

So, I think it can be. If you look at the Australian system for example, I believe that that might be a better model than thinking about Canada, where we’ve essentially got a base with where everyone’s in the same primary care system, we have the right to trade up with your own money, not to a different level of outcome, but to a little bit better amenity, and you get employers out the way and you make that a consumer choice.

Ian Morrison:

I think there are ways in which you could build what I’ve called the floors and ceilings model, where you have a basic floor below which no American falls, and the right to trade up to certain things when you don’t have money, provided those differences are not dramatic in terms of clinical outcomes or health services.

Sarah Dash:

Great, thanks. Well, just in closing, a third of the world’s new normal have come up various times over the last few months, and I know it’s a little hard to tell yet. Do you have any guesses as to what a new normal in healthcare could look like in the near term like next couple of years?

Ian Morrison:

Well, I was with the board of an insurance company just a couple of days ago, and one of the things that came up was one of the board members run a medical university that trained allied health professionals, and she was telling me that since the pandemic, there has been an explosion in interest of people wanting to get into the healthcare system, not as a moneymaker, but as a calling.

Ian Morrison:

I actually think that one of the things that we will reflect back on is what this has done to public attitudes towards caregivers, to the health professions. And in actual fact, I think while we’re going through this very difficult next three months, we will probably emerge on the other side celebrating our health system greatly, which will make it maybe a little bit more difficult to tamper with the game, if you like, from a policy point of view.

Ian Morrison:

But I do think the upside of the pandemic will be if we can use and harness the engine of innovation, and the speed and agility of reforming to change the way we deliver care, that’s more humane, that’s more equitable, and that’s more innovative, quite frankly, going forward. That would be a good new normal for us to achieve.

Sarah Dash:

Thank you Ian. Well, with huge gratitude to those who are on the frontlines caring for COVID patients, trying to prevent those cases, who are working in the labs to develop the vaccines and the tests and the treatments, we are grateful for that. And Ian, I’m grateful to you for spending the time with us at the Alliance today, to talk about what the future may hold.

Ian Morrison:

My pleasure. Thank you for having me.

Sarah Dash:

Thank you. And with that, don’t forget to join us for our next panel at noon.