The one big winner of the Obamacare wars

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The Trump-era attack on the Affordable Care Act has left the nation’s health system plagued with uncertainties: Will “Obamacare” insurance survive? Can independent hospitals make it? What’s next for doctors? And will patients ever really get “affordable” care?

But one certainty is prevailing: No matter what the outcome, it will be a bonanza for health-care consultants.

Health care, as the current president famously noted, is complicated­—and the past decade of change has generated an immense new market for consultants, advisers, and a whole universe of ancillary experts who don’t practice medicine but promise to help navigate a landscape that seems to change every six weeks.

From the newly minted college grad with a degree in health policy—an undergraduate major that scarcely existed a generation ago—to the copiously credentialed M.D.-MBA-JD-MPH-Ph.D. consultant, American health care has no shortage of saviors.

Some have brilliant insights that save lives and trim costs; others mainly generate invoices.

These fixers—the visionaries, the mercenaries and everyone in between—have been dramatically increasing their role in the economy since the Affordable Care Act was passed in 2010.

A Modern Health Care Magazine survey of just 25 prominent national consultant firms found that revenue rose from $2.3 billion in 2008—the year before Obama took office—to $6.6 billion in 2014, the start of the ACA coverage expansion. Deloitte, for instance, which topped the list in 2014, saw its health-related revenue rise from $725 million to $2.2 billion in that time.

“Health care is an industry that’s still in the Bronze Age technologically, struggling with wave after wave of massive disruption,” said John Gorman of Gorman Health Group, one of numerous consultants, ex-consultants, government officials, doctors, academics and health care administrators interviewed over many months.

Today, despite the GOP’s attacks on the ACA—and sometimes because of those attacks—the consultant universe is still flourishing. IBISWorld, a market research firm, says the sector has been growing by more than 7 percent a year, and predictshealthy growth in the years to come.

Well-known consultant Paul Keckley came up with an estimate of $20 billion a year just for “health care management” consulting. And those estimates are only rough indicators; there’s no standard definition of who is a “consultant”; industry surveys don’t include the vast array of nonprofits, advocacy groups and government agencies that pump out all sorts of reports and advice of their own.

“We’re tripping over each other,” said Ian Morrison, a consultant and “futurist” who is a popular fixture on the health care lecture circuit.

The reasons for the health care fixing frenzy are varied: Digitization forced doctors to abandon their bulging file folders in favor of computerized records. Obamacare expanded insurance coverage at a pace not seen since the creation of Medicare in 1965—and Trumpcare has begun to contract it.

And doctors, hospitals, government and the private sector are all grappling with how to pay for medical care in ways that reward the quality, not quantity, in a system that may not really be the “best in the world,” but is certainly the most expensive.

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