The United States of Healthcare (SM) (Part 8)

The United States of Healthcare (SM) (Part 8)

A Post COVID-19 United States


When we began our blog series, “Healthcare 2030” on September 24, 2019, we noted the importance of healthcare not only for the United States, but also for the entire world.  In recent blogs, we’ve noted the problem segments of healthcare and where opportunities lie going forward.  Who could have imagined in September of last year, the world would have changed so drastically in six (6) months?  We were noting what we saw as the cracks in the road ahead, but those cracks have widened into canyons.  Under the pressure of this unprecedented world crisis, the largest most robust and resilient industry in the U.S. put to the “acid test,” the U.S. healthcare industry continues to be “stress tested” beyond what any competent healthcare professional would have predicted.


Prior to the COVID-19 outbreak, many experts thought the estimates of healthcare growth to 25% of GDP by 2030 were overly aggressive.  Current projections are being restated and increased substantially in many segments.  We are certain that healthcare will change dramatically based on this crisis and for such a deeply entrenched industry this is truly significant.


We have witnessed changes, at least temporarily, that would previously have been unprecedented, removing restrictions at the national and state levels.  The government representatives in the U.S. Northeast should be realizing that the severe constrictions they placed on the healthcare infrastructure, such as restricting new hospitals, hospital expansions and limitations on the number of hospital beds, has severely compromised their ability to respond effectively to the COVID-19 emergency.  As we have predicted in these blogs, that will be permanently changed.  America has a new “moon shot” project.


As a student of healthcare, I cannot help but be excited by the opportunities ahead that will allow, if not mandate, change in the interactions and relationships between patients, providers, payors and government.  Healthcare is quite clearly stumbling into a dramatic transformation that was unpredictable.  This historic event will be studied for decades into the future, where every bit of data is on the internet forever; not just grainy pictures of people and scant newspaper headlines reflective of the Spanish Flu of 1918.


It appears that much of the transformation is in driving greater use of technology which is substantially the areas we have been investing in personally and know well, such as IoT, use of advanced technology (well beyond EHRs) and enhanced delivery of care systems.  In our last blog, we noted the challenges faced by hospitals and providers.  We noted that one healthcare delivery system was close to reorganization, and in 24 hours after we alerted, they filed for protection under the bankruptcy rules to allow them to reorganize.  Many will follow and tens of thousands of hospital and outpatient professionals will continue to be furloughed; temporarily we hope.


While working from my home office with the television running in the background, I heard Walter Isaacson – one of my favorite analyst, author, journalist, historian, and professor, who is also a CNBC contributor and former CEO of the Aspen Institute – speaking as a guest on “Squawk Alley” discussing biotech’s efforts to treat the coronavirus.  Please see his video comments at


I think he is correct!  We have indeed entered a “new era” – he called it “the biotech generation” – whereas the “technology generation” and what I would call ’consumer technology’ has passed.  However, biotech’s definition is too narrow and, I believe, too small.  The entire U.S. healthcare industry (pre-COVID-19) is, or more appropriately was 18% of GDP which includes all of pharma and biotech.  Pharma is about 11% of healthcare or about 2.0% of GDP and that is a super narrow field that employs even less proportionally than the 2.0% implies.  What I believe we can say is that ‘we have now become the healthcare generation, including refocusing technology for health and wellness.’


We have witnessed existing comorbidities (pre-existing conditions) have been one of the key contributing factors for the somewhat higher percentage of mortalities in Black and Latino communities. Social Determinates of Health [1] is a relatively new term.  In the early 1990s, we were opening medical centers in urban settings and we knew the problem, it just did not have a fancy term created by academics.  We had to care for patients not just in the clinics, but also in their homes, providing almost free transportation and even food.  Realizing that as a company we had to go beyond medicine and into the “total care” of the patient.  Clearly, going forward we must redesign our education, delivery of care, as well as dramatically increase the use of technology in healthcare.


We see healthcare reforming, or maybe rebuilding due to COVID-19 in a way that no single President or even generations of Presidents and Congresses could ever do.  We will see a “healthcare rebuilding” that will change everything.  I believe the big winners will be society and patients; hospitals, medical providers and the historically “low tech” healthcare industry will finally be brought into the 21st century.


We will dive deeper on this in our next blog.


Editorial note: Going forward, we are going to rename our blog, The United States of Healthcare (SM) as it is now self-evident to anyone.  We are also working on a book that will have the same title and will summarize how we have arrived at this point and what we can do going forward to flourish now that healthcare is the de-facto, the single largest industry in the United States of America.