This post entitled “What the State of the Union says to us” is written by Geoffrey Dalander, the vice president of reporting and data management at OptumHealth (United HealthCare)

What the State of the Union says to us

“The President’s state of the union touched on healthcare as a key area of concern for his remaining term. The bald statement: “the biggest driver of our long-term debt is the rising cost of health care for an aging population” gives meaningful Medicare reform as large a spotlight as healthcare reform itself.
My reading is Simpson-Bowles would ask seniors to pay more, and that doctors, hospitals and pharmacy companies take less. It also tries to change behavior by eliminating ‘first dollar’ coverage and changing the rules by which the so-called “Medi-Medi” population are handled.

On an editorial note, I’m concerned that a crimp in medical Resident’s salary will dis-incent certain individual from seeking medical education when we’ll need more primary care providers than ever. On the other hand the marginal ask of pharma seems like it could be strengthened from rebates to volume discounts for one of the biggest organized pool of consumers in the world.

The president did touch on basic research in the human genome, brain mapping and drug development as part of a long list of things we should invest in.

Interestingly, it was only when talking about armed forces and veterans did he mention mental health. That topic got a lot of attention in discussing gun violence at the inaugural.So what does it mean for us in the business of healthcare? Certainly more scrutiny and record keeping. My hope is that is also spurs innovative approaches to managing chronic and urgent conditions – I believe there’s a huge pent-up demand for those services, come 2014 when 40 million additional Americans come on the rolls. And let’s not forget ICD-10. Busy time.”


The state of the union does not address the fact that with increasing difficulty in finding physicians, auxiliary services will take on a key role.  Nurse practitioners and patient assistants will become the healthcare providers that many people will derive their care from  and in many states, they are already not required to have a physician oversee any of the charts, recommendations or actual treatments.  More legislation is appearing to make independence in their practice possible in more states until many will see the family physician as superfluous.  Interestingly, the cost of seeking out a consultation or examination with many of these practitioners, is not less costly than seeing a physician.

Yes, we live in interesting times.

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