There is a 50 percent likelihood of a complete government shutdown over the coming months, said former U.S. Labor Secretary Robert Reich at Monday's opening keynote at the HIMSS11 conference in Orlando, Fla.
Increasing partisanship has made political agreement over the federal budget unlikely, Reich said, although the battle is over only 12 percent of discretionary spending in the budget. But, he said, the most important long-term problem facing the nation is Medicare.
"That's the 3,000 pound gorilla," Reich said. "But if we just control Medicare costs and do nothing about increasing healthcare costs underlying Medicare, then you will have a political outcry. That will be a real budget crisis."
Reich predicted that improved patient outcomes would be the key metric for payers in the future. He said accountable care organizations would be essential in the future healthcare payment universe.
"I don't like to use the word 'capitation,' but that's the reality," Reich said.
He also predicted Republicans would successfully repeal the individual mandate in the healthcare law, and that some kind of medical tort reform would make it through Congress.
In general comments about the state of the U.S. economy, Reich said it was instructive to remember that the economy doubled in size over the last 30 years, but wages remained stagnant.
He said an increasing concentration of wealth at the top of the U.S. income strata has meant that the vast middle classes do not have the purchasing power to keep themselves out of debt.
"We are trying as a nation to get out of the gravitational pull of the recession," Reich said. "This recession started with the explosion of a big asset bubble. It's not easy to come out of a recession like that. The Fed has been holding interest rates near zero for quite a while, but there has been no improvement."
HIMSS Board Chair C. Martin Harris introduced Reich. Prior to his introduction, Harris touted the technology-driven transformation of healthcare, saying that it is poised to utterly change the practice of medicine.
"We will see the promise of medical research invigorated," Harris said. "Research is driven by data. Patients will receive the right treatment at the right time from the right provider, as efficiencies are achieved. Meaningful use is just the beginning."