American Healthcare Predictions: ‘There will be a place for “Business Class” and even “Boutique-Concierge Medicine” for those companies and individuals who wish to have more than Economy Class and are willing to pay for it.’– Part 2: Policy and Politics


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July 29, 2014 – Hello and welcome. I am Dr. George Lundberg, and this is At Large at Medscape.

This column is a response to the recent request from the good folks down at Louisiana State University in New Orleans for a set of predictions about the near and distant future of American medicine, as a follow-up to some I made there in 1990.

As Yogi Berra famously said, “Predictions are hard to make, especially about the future.”

Anyway, here goes:

1. The Affordable Care Act, also known as the ACA or Obamacare, will not be repealed or replaced. But it will be revised, probably a lot.

2. All 50 states, recognizing the idiocy of refusing, on ideological grounds, billions of federal dollars to help care for their medically indigent, ultimately will accept the Medicaid extension of the ACA and take the money to better care for their people.

3. The Republicans, fully utilizing gerrymandering, will retain control of the US House of Representatives well into the 2020s, until immigration and propagation of minorities, combined with the dying off of old white people, convert present minorities into the majority.

4. The US Senate will bounce between Democratic and Republican control, even every 2 years, but it will not matter because neither party will exceed 60 senators, so the filibuster will continue to foster gridlock on many issues.

5. The Presidency will remain under Democratic control for the foreseeable future unless one or more third parties arise to make the US look more like Europe, with multiple parties and shared governance. This could even come about by revolution, if there is another worldwide financial meltdown and the people reject overt rule by oligarchs and oligarchy, and even greater wealth disparity.

6. More likely, a Republican Congress, motivated by Christian compassion, freedom of choice, and fiscal conservatism, will insert a new public option into the ACA. By a wave of public demand, and in order to restrain costs, the public option will grow into “Medicare for All,” private medicine with public funding for “Basic Health Care.” There will be a place for “Business Class” and even “Boutique-Concierge Medicine” for those companies and individuals who wish to have more than Economy Class and are willing to pay for it.

7. Health insurance companies will largely disappear, their relative uselessness having become widely recognized.

8. Medicine, having been freed from the shackles of rampant medical capitalism, will return to its eternal roots and become again a learned profession.

The next At Large column will provide additional fearless predictions on clinical and scientific topics.

That is my opinion. I am Dr. George Lundberg, at large for Medscape.


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