Are you a fan of the musical "Hamilton"?
Then you might recognize the similarities between the establishment of the U.S. central banking system and the Affordable Care Act (ACA).
Basically, Alexander Hamilton (who was the first Secretary of the Treasury) started a movement in 1780 to create a central bank to improve the economic stability of America after its independence from Britain. Part of a three-part expansion of federal fiscal and monetary power, it included a federal mint and excise taxes.
The Bank of the United States was to be used as a tool for government, but it was to be privately owned.
Hamilton's bill faced widespread opposition from those who feared increased federal power. Sound familiar? But it passed and over the next 130 years became the foundation for the Federal Reserve banking system as we know it today.
Current Political Environment's Impact on Healthcare Design
Sarah Bader of Gensler and I used this story to help set up our discussion of the current U.S. political environment at our "Let's Talk Trends" interactive session this week at the Healthcare Design Expo & Conference in Houston.
With a U.S. president-elect promising to repeal and replace Obamacare, we told our group that just like those who wanted to do away with the national bank in the years after it was established, we didn't think it was possible to completely unravel the ACA.
After all, it's a very complex bill, and many of the changes to improve how healthcare is delivered and lower costs, such shifting from fee-for-service to value-based payments, are already underway.
We asked them what they thought is going to happen when the new president takes office and how it is going to affect healthcare facility design and construction.
What the Healthcare & Design Community Thinks
A gentleman raised his hand and said that before we even ask the question of what's going to happen, we need to know what is going to change. "We only know what we think is going to happen," he said.
Well, rightly so.
A gentleman from Turner Construction spoke up next. He said that from their perspective, everything not currently underway is being put on hold and that we'd see a dramatic slowdown of new healthcare construction in 18 months. Architects, he predicted, are going to suffer.
Not so for another architect in the group. He said one of his clients had called him the day after the election and told him everything was going ahead as planned.
This was echoed by another architect who worked for a healthcare system. Others were not so sure.
When all was said and done, it was clear that many in this group of @60 healthcare design and construction professionals and vendors were not quite ready to put forth any opinions.
They were still processing what had happened in the election. And most were not happy with the outcome.
In fact, not one design and construction professional or vendor I spoke with during the four-day conference was happy with the election outcome. Even some of my Texas colleagues. But of course, we're only half the country.
Want to Know More?
This past week Trump backed off some of his campaign promises about Obamacare. If you want some more opinions on how this is all going to shake out, check out these recent articles:
"The GOP’s path to ‘repeal and replace’ may not be so easy," Kaiser Health News, November 16, 2016 (podcast/transcript)
"Value-based care will likely continue under Trump," FierceHealthcare, November 15, 2016.
"Trump wants to repeal Obamacare. What of payment reform, ACOs, innovation?" MedCity News, November 9, 2016.
"Trump upset will force healthcare leaders to rethink the future," Modern Healthcare, November 9, 2016.
Next week, I'll write about the other topics discussed during our session at the Healthcare Design Expo and Conference, which were Urbanity, Patient Experience Movement, and Demographics.
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