1) if US goes with taxpayer funded healthcare, expect pay to go down similar to other developed countries with taxpayer funded healthcare. Because there will be no negotiating power.

2) with the ACA framework, it’s a race for insurers, hospitals, and physicians groups to get as big as they can do they can gain as much negotiating power as they can. I can see it with all the M&A in the hospital and provider space, and the rule of thumb is “the closer you are to the money, the more you make”. In this case, insurers will hold the money, so it will be at their mercy that they approve or deny payments for certain procedures.

The American people themselves don’t have enough money to continue paying for this gravy train, and the government was picking up the slack, but I think that’s going to be over soon.

The CVS/Aetna vertical integration model is interesting too, as they are talking about adding doctors to their stores to make it a one stop shop. Insurance, provider, medicine all in one, similar to Kaiser.

And then there’s doctor groups who are able to pump out more work from one doctor by using physician assistances and nurse practitioners to actually see patients “supervised” by one doctor, but the doctor never actually sees the patient.