Goodbye, 2020. Hello, 2030.

2020 is almost over; thank goodness.  It has been one of the strangest, and longest, years most of us have ever endured.  We’ve all probably known someone who contracted COVID-19; many of us have had lost loved ones from it.  Most of us have had to make drastic changes to our lives – masks, social distancing, limits on family visits, eating out, concerts, or trips among them.  No, 2020 can’t get over fast enough.

I was struck, though, by a quote I recently read.  Loren Padelford, a vice-president at Shopify, told The Wall Street Journal: “Covid has acted like a time machine: it brought 2030 to 2020.” 

Gosh, I hope not.

Credit: Getty Images

Mr. Padelford went on to explain: “All those trends, where organizations thought they had more time, got rapidly accelerated.” These trends include the shift from physical to online, further decline of cash, and work from home/remote learning.  Individuals/families without broadband are being left behind; companies not investing in IT and logistics may not be here in 2030.  Healthcare has not been exempt from these trends.

The pandemic has illustrated both the great strengths and the great weaknesses of the U.S. healthcare system.  Among the strengths are the courage and professionalism of our health care workers, the innovation that has delivered several vaccines within a matter of months, and the ability to adapt to an existing but underutilized mode of care in telemedicine. 

Among the weaknesses, of course, are the lack of planning and coordination that has doomed testing, contact testing, and supply of personal protective equipment; the patchwork quilt of insurance coverage that has left even more without coverage (e.g., due to loss of job based coverage and/or lack of Medicaid expansion); the refusal of many to act in their own best health interests, such as not wearing masks or taking vaccines. 

Credit: Mark Felix/Getty Images

Legislators/regulators may be taking bold actions like throwing money at healthcare organizations, vowing that the COVID testing and vaccines are “free,” and loosening restrictions on telemedicine, but the underlying disfunction in our healthcare system has never been more visible.  We don’t test enough or fast enough.  We have sick people on gurneys in gift shops, we have dead people in refrigerator trucks, and we still have people crushed by their healthcare bills.

Please, don’t let this be a picture of 2030.

2030 is a decade, three Presidential administrations, six Congresses, and hundreds of state/local governments away, so it’s hard to predict what healthcare might look like then.  Some think our current crisis is the perfect opportunity to take big, bold political action on healthcare, and it should be, but I must admit I’m dubious we’ll take it.

Instead, I’ll offer a few more measured – but important -- hopes for 2030:

Ensure a floor of coverage: ACA was supposed to achieve this, but a Supreme Court ruling and a number of ideological states kept it from happening.  I don’t know if we’ll ever get to true universal coverage, be that “Medicare For All or something else, but we should at least be able to ensure that cost is not a barrier to coverage for anyone, especially for the poorest among us.  Maybe we should shoot for “Medicaid For All” and let those who choose “buy up.”

Claire DeRosa/Wisconsin Watch

Ensure a ceiling for spending: Again, ACA addressed this, with out-of-pocket maximums and cost-sharing reductions, but too many people still end up spending too much of their money on healthcare (think about surprise bills or non-covered services).  A healthcare system that drives people into bankruptcy and/or takes them to court for services they cannot afford is just indefensible.  We should stop defending it.

Oriented around virtual care: Telehealth/telemedicine/virtual care has been around for at least two decades, but barely was a ripple in the healthcare system until COVID-19 sparked it into prominence.  However, right now it still is being bolted on to our system, rather than being truly integrated, and those bolts aren’t even all that strong.  By 2030, virtual care – in whatever form it may take by then (think AI/holograms/etc.) should be part and parcel of all health care, the first point-of-contact for most needs. 

Quality first: We talk about quality in healthcare, but we don’t really know what it is, much less measure it.  Our various attempts at payment reform have failed either to improve quality or to control costs, and will continue to do so as long as there is not agreement on the quality that is delivered for those payments.  In a world of continuous monitoring, there’s no reason for us not to know which patients got how much better through what interventions from which health care professionals.  That information would allow us to tie reimbursement appropriately to quality of care/outcomes.

Big picture: In the big picture, health is not just connected to medical care but also to vision and dental care.  In the big picture, health is not just connected to care but also to lifestyle and environment (SDoH).  In the big picture, our microbiome is integral to “us” and to our health.  But most of our healthcare system and our solutions to improving it focus mainly on the smaller, medical picture.  That it so 19^th century of us, yet 2030 brings us almost a third into the 21st century.  We need to think much, much bigger – starting now.

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December has been the worst month of the pandemic in the U.S.  Many experts think that the worst is yet to come, despite vaccinations beginning.  2020 may be ending but what has happened in 2020 is going to have a long and very unpleasant tail. 

2020 is a decade after ACA passed, and, let’s be clear, our healthcare is much better for it.  But if 2030 doesn’t find us with significantly more improvements than the 2010’s brought us, well, expect many more bad years like 2020. 

We can muddle through another decade of incremental improvements in our healthcare system.  We can lurch from crisis to crisis, addressing each without tacking the underlying weaknesses that allow them to become crises.  We can continue to astonish the world with our profligate spending and very mediocre outcomes. 

Me, I’m hoping 2030 will astonish us by how far we’ll have come.