Health Care Scenario Planning Report
COSE completed an extensive scenario planning project designed to frame the potential health care future of the year 2015. We believe the findings of this process provides a platform for national discussion about the future of health care in the United States while representing the needs of small business. In addition to framing ideas about the future of health care, these findings will also help current players in the system consider their own alternatives in the face of alternative futures. More importantly, COSE will work to engage federal and state policymakers, elected officials and candidates as they devise their health care ideas – ensuring the needs of small business are articulated and advocated.
With the cost of health insurance steadily rising, the number of small businesses able to offer health insurance to their employees shrinking, and the presidential election just ten months away, COSE leadership believed the time was right to frame a discussion about health care that will take into account the concerns and the needs of small business both in the state and the nation. According to the Kaiser Family Foundation, 46.5 million people did not have health insurance last year, and small businesses encompass a growing segment within that population. Kaiser’s 2007 Employer Health Benefits Survey shows that 45 percent of small businesses or firms with three to nine workers offer health insurance today, which is down from 57 percent in 2000.
“COSE has been an active advocate and provider for small business health care for more than 35 years. This process has allowed us to connect our experience and imagination to see new ways to confront the issues. Short-term fixes will only plug holes, not reform the system. We need policymakers to think long term to fully understand the impact their decisions will have on the whole system. The health care crisis is a critical small business issue. We’re committed to developing a solution that addresses the needs of small business,” said Steve Millard, COSE President and Executive Director.
During the past year COSE assembled a diverse group of business leaders, health care professionals and policy experts with exceptional perspectives to envision possible futures for health care. The scenario planning exercises were conducted by Global Business Network (GBN), the world’s foremost scenario planning research and consulting group.
The group conducted two scenario planning sessions along with follow-up teleconferences on the health care system and where it might end up in the face of a number of complex and unpredictable factors. The end game was to frame the four most likely futures, to share findings with policymakers and also to determine the specific threats and opportunities for small business in each scenario. “This work not only helps us to better serve our members but will also serve to open the dialog with decision makers as they grapple with health care reform at the state and national level,” said Lou Licata, immediate past COSE chairman and president, Licata & Toerek.
The report does not prescribe a specific answer to health care reform. The scenario planning process was designed to expose how different future realities could impact multiple parts of the vast health care system. Reform ideas like universal-care, individual mandate and health care accounts that look like 401(K)s come with a bundle of consequences. Policymakers need to understand the lasting impacts that any of these reforms may have on all aspects of health care, especially on small business, which represents 80 percent of the economy. COSE is confident that the process has yielded a compelling tool that can be used to understand the impact that decisions may have on the system in the future.
After completion of facilitated discussions at two major conferences, the group reached consensus on two significant issues that may have the biggest impact on the future of the future of health care in the United States: the urgency for change in U.S. health care, and who will be seen as responsible for reforming the system. Depending on whether the urgency for change is growing and concentrating or is dissipating, and depending where leadership for change emanates – whether it will be today’s established players or it will be new sources of energy and ideas, four alternate futures for health care were envisioned and described.
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Scenario 1 – Where’s the traction?
The first or “status quo” scenario envisions health care insiders as having no incentive to reform the system, leading to continued erosion of benefits and functioning of the system. Cost shifting to those left in the system provides “band-aid solutions” while the number of uninsured continues to grow.
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Scenario 2 – Don’t just stand there – do something!
The second scenario sees popular demand (the pinch of high health care costs) forcing powerful players such as the federal government to make quick but far reaching decisions about health care. Employer mandates and price controls are more prevalent
and the system evolves into a minimally federally subsidized program.
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Scenario 3 – No news … good news?
Evolutionary change characterizes the third scenario as the urgency for health care reform takes a backseat to other domestic and international political issues. In this scenario, consumers take more control of their own health and health care and market forces slowly bring change to the industry. Individuals and small business are caught up in a rapidly changing, confusing policy and benefits environment.
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Scenario 4 – New powers, new systems.
In the fourth scenario, in the midst of intolerable costs and a system in need of reform, new players and organizations step in to offer a different take on health care and its financing. New alliances emerge and significant changes in practices cut medical costs. Health information systems arise to become agents of change.
The details of each scenario, including “stories” of how they might impact individual small business owners, are developed in the report and provide policymakers a framework for discussion about health care reform.
COSE recognizes that change is inevitable, and while the organization does not seek to provide an answer or specific direction for reform, it urges small business owners and those who represent and support them to be actively engaged as the process begins to unfold.
COSE challenges those serving to consider the scenarios and determine how to address the needs of small business as they devise their positions on health care.
Download a complete copy of the report HERE.