Joe FiferIn our family, we don’t talk about politics at the dinner table. Many families engage in political debates over holiday meals and enjoy it. Not us.


This year, however, I edged dangerously close. With 12 of us at the Thanksgiving dinner table (ages ranging from 21 to 89, and political leanings of red, blue, and purple), I opened the discussion: “Without getting into a debate about what should happen or what’s good or bad, I’m interested in what you, or people you hang with, really think about health care.”

The answers were overwhelmingly about money. They told stories about high out-of-pocket costs, good (or lousy) benefit plans, and problems accessing care due to financial barriers. With only one exception toward the end of the conversation, they talked about only financial issues, not quality.

As it turns out, my unscientific little focus group is fairly representative of society’s concerns about health care today. Case in point: Among people participating in a recent survey who said the healthcare system does not work well for them, 65 percent complained that it’s too expensive. Most said the system needs reform and is too politicized. Many described their attitudes toward the system as sad, pessimistic, or angry. Less than one-third of parents believed health care will be more affordable for their children as adults than it is for them. Quality issues were secondary.

This study, The State of Health Care in the United States, was not sponsored by a research organization, a think tank, or a consumer group. It was sponsored by CVS Health, the retail pharmacy company. As everyone who follows healthcare news knows by now, CVS has agreed to buy Aetna, one of the country’s largest health insurers, in a deal that could reshape the healthcare industry, for better or for worse. Having published its report days before news of the deal broke, CVS used it as a platform to articulate views that drove the strategic move. “Public opinion underscores the widespread desire to evolve today’s healthcare system into one that is affordable and sustainable for today’s healthcare consumer and for generations of Americans to come,” the report says. It concludes that CVS’s business model and reach—touching the lives of one in three Americans—make it well positioned to tackle some of the nation’s biggest healthcare challenges, from escalating costs to rising rates of chronic conditions.

This research bears out what many of us already know: When it comes to health care, affordability is the major issue on people’s minds today. As HFMA has been advising for a while, traditional healthcare stakeholders must embrace consumerism, not merely tolerate it. Futhermore, health systems and physicians must figure out how to collaborate with health plans to reduce the total cost of care and pass the savings through to patients and other healthcare purchasers.

What’s new in all of this is the urgency. Traditional stakeholders must make these changes quickly, because nontraditional competitors—in this case, an entity with nearly 10,000 retail locations—are already there.


From the President's Desk


January 2018: From the President's Desk: Joe Fifer on Healthcare Affordability

Joe Fifer expands on his ideas in his January column.

Follow Joe Fifer on Twitter: @HFMAFifer

Publication Date: Friday, December 29, 2017