I had the great privilege of listening to Paul H. Keckley, Ph.D., speak last week at the Healthcare Marketing & Physician Strategies Summit in Austin. Paul is a noted healthcare policy expert, speaker and the managing editor of The Keckley Report, a weekly healthcare policy review.

In 2009, he negotiated a deal between all the major industry trade groups (AHIP, AMA, AHA, AdvaMed, BIO and PhRMA) to help shape the Affordable Care Act (ACA) as we know it today. While he admits that the ACA is not perfect by any means, his experience shaping the law and his long history as a healthcare policy expert make his perspective valuable.

Here are the 13, or a “baker’s dozen,” of my top takeaways from his talk in Austin. It’s important to note that this is not a transcript, but my interpretation of his points. For healthcare marketers, point 12 is of particular interest.

1. The ACA is not a perfect law and “has many hanging chads.” It was a compromise between public and private interests.

2. The ACA will be the law of the land for some time to come. It will remain so in the near term due to the upcoming election year, in 2018. Healthcare law is intensive and will take months to broker.

3. The AHCA discussion has been based on “voodoo economics” and is largely focused on the insurance premiums, ignoring many important provisions within the ACA. This is due to politics preying on consumer ignorance and lobbying dollars spent to protect the system and the status quo.

4. The AHCA would put the debt burden on the states and individual health systems. It’s forcing us to answer the question “Is healthcare a right or a privilege?”

5. Secretary of Health and Human Services Tom Price is physician-centric, and ACOs and bundled payments will most likely remain if it’s a voluntary decision for doctors and not mandated. Price is not so keen on meaningful use and hospitals employing doctors.

6. A political decision needs to be made. Do we let healthcare continue to grow to be one-sixth of our economy because it produces jobs and fosters innovation that benefits the world? Or instead, do we put the clamps on because healthcare has “had a good run” to get the deficits in order to lower our potential to be disadvantaged in a global marketplace?

7. We need to decide to either let healthcare remain a private industry in a free market or transition to a government system. We are challenged because “Joe Sixpack” doesn’t understand anything about how either system operates.

8. There is a general sense from the population that something is wrong with the healthcare system. Half of all individual bankruptcies are due to medical debt. A majority of senior citizens are seeing their savings depleted due to end-of-life care. 27% of the Medicare spend is at end of life.

9. We spend $10,400 per person every year on healthcare in the U.S., and 14% of this spend is out of pocket, so “Joe Sixpack” is starting to feel it. This type of impact is making it more likely we will see a referendum for some type of single-payer system in 2020.

10. Ultimately, the majority of Americans feel that “healthcare is a right, not a privilege,” and 75% of people under 45 feel that we should have a single-payer system, even though most don’t really understand what that is.

11. A type of two-tiered single-payer system could eventually emerge where those who can afford it will have private insurance and those who can’t will be on a government plan.

12. If we do adopt a single-payer system, marketing and communications budgets and the tactics used to connect with consumers could change. In particular, data, technology and CRMs could have an increasing role as the primary way engagement occurs. Marketing and communications should continue to play an important role as consumer choice would remain as a part of the landscape if a new system emerges.

13. Paul’s “utopian view” of an optimal healthcare system is when all healthcare organizations in the country follow a capitated integrated delivery system model where insurance is integrated with delivery. However, a minority (only about 102 systems in the U.S.) have these types of capabilities. This is not a model that Secretary Price is a fan of.

To read Paul’s recent post on this topic, visit: “Health Reform: What’s Next?”

Also check out his most recent post: “Rethinking Branding in Healthcare”