2020 is bringing us to a fork in the road for the future of American healthcare. Will we choose to empower the government or the free market in medical care? Will that choice be driven more by leaders in government, or leaders in the healthcare sector? What’s happened in just the last eight months, and what will happen in the remaining four, will go a long way toward answering these questions.

Thus far, 2020 has brought increased support on the political left for universal, single-payer health coverage – empowering the federal government to dictate prices of medical care to doctors and hospitals. It could help control costs, but it would also significantly reduce access.

Additionally, 2020 has generated widespread deregulation, including in medical care in response to COVID-19. Upfront transparency in medical prices has also made inroads in transparency regulation and legislative advocacy. When combined with approaches designed to help patients control their medical costs, this would lead to lower-cost, higher-quality care.

Many things will influence the future of American healthcare, such as the 2020 elections, policy debates leading up to and following the election, and legal challenges to regulatory and legislative policy decisions. But perhaps the most important decisions lie with the healthcare sector and medical professions themselves.

Healthcare industry players and medical professionals have offered opposition to both of the competing approaches being offered to the American people. For instance, the American Hospital Association and other hospital groups are plaintiffs in the lawsuit challenging the federal price transparency rule, and they have gone on record opposing single-payer systems. The American Medical Association (a national association of doctors) has similarly opposed a single-payer system (it has voiced support for price transparency).

The interesting thing about this opposition to reform is that if the healthcare sector changed by itself, on its own terms, it could largely eliminate the need for the reforms it opposes. If hospitals began offering patients out-of-pocket price quotes prior to doing surgeries and more routine care – accounting for the patient’s insurance coverage and deductibles – the price transparency regulation they oppose would become a moot point. By the same token, if hospitals took transparency a step further and actively competed based on out-of-pocket patient costs, they would significantly curtail the rise in healthcare costs that is generating support for single-payer health coverage.

All of this points to the bigger, unspoken debate we are really having about healthcare in 2020: Will the healthcare sector change itself, or will public policy force it to change?

The only certainty? Few are content with the status quo, and the public’s discontent will likely only increase until we see healthcare reform that effectively reins in the costs of medical care. 

What form that change takes is largely in the hands of the healthcare sector. It can control it by proactively taking steps to change, or it can be controlled by continuing the status quo until policymakers force changes.

These decisions will not all be made in 2020. But this year will go a long way toward deciding whether healthcare reform will be driven by public policy or the healthcare sector. 

It will also go a long way toward deciding whether America’s healthcare future means a bigger government or a freer market.

In both cases, the wise and courageous path will be the latter.